Reproductive health : findings from the Australian Longitudinal Study on Women’s Health. Chapter 3: Use of contraception

Chapter 3: Use of contraception. p15-32 Key findings: This section examines trends in the use of contraception between 1996 and 2006 by women who participated in the surveys for the 1973-1978 cohort of the Australian Longitudinal Study on Women’s Health. 1. The oral contraceptive pill was the most commonly used method of contraception at each survey, but its use decreased over time. 2.Of women who consistently used contraception, 40% used the oral contraceptive pill as their only method of contraception in at least three out of four surveys. 3. The proportion of women using condoms as their only method of contraception remained steady over time (15-18%) but only 3% of all women used condoms only at every survey. 4. The proportion of women using both condoms and the oral contraceptive pill remained steady at 13-14% of all women from Survey 1 to 3, but decreased to 8% of all women at Survey 4. 5. The use of methods other than the oral contraceptive pill and/or condoms increased at Survey 4. 6. The proportion of women using an implant (e.g. Implanon) remained steady between Surveys 3 and 4, with 3% of women using an implant only. Around one third of implant users at Survey 3 continued to use this method at Survey 4. 7. The main reasons for not using contraception at Surveys 3 and 4 were pregnancy, trying to conceive, or no male sexual partners. 8. Women who used contraception were more likely to be in de facto relationships or single, be up to date with Pap tests and have had two or more births. 9. Women who did not use contraception were more likely to be non-drinkers and/or do low levels of exercise, have had one birth and have experienced miscarriage. 10. Contraception changed in expected ways according to reproductive events: women who reported only miscarriages between surveys also stopped using contraception in the same period; most women who did not report reproductive events continued to use the same method of contraception; and women who had a termination tended to switch methods.

Technological-forecasting and research inputs in area of birth-control technology

Technological forecasting, defined as quantified probabilistic prediction of timings and degree of change in the technological parameters, capabilities desirability or needs at different times in the future, is applied to birth control technology (BCT) as a means of revealing the paths of most promising research through identifying the necessary points for breakthroughs. The present status of BCT in the areas of pills and the IUD, male contraceptives, immumological approaches, post-coital pills, abortion, sterilization, luteolytic agents, laser technologies, and control of the sex of the child, are each summarized and evaluated in turn. Fine mapping is done to identify the most potentially promising areas of BCT. These include efforts to make oral contraception easier, improvement of the design of the IUD, clinical evaluation of the male contraceptive danazol, the effecting of biochemical changes in the seminal fluid, and researching of immunological approaches and the effects of other new drugs such as prostaglandins. The areas that require immediate and large research inputs are oral contraception and the IUD. On the basis of population and technological forecasts, it is deduced that research efforts could most effectively aid countries like India through the immediate production of an oral contraceptive pill or IUD with long-lasting effects. Development of a pill for males or an immunization against pre gnancy would also have a significant impact. However, the major impediment to birth control programs to date is attitudes, which must be changed through education.

Prescription contraception use: a cross-sectional population study of psychosocial determinants

Objective: Many forms of contraception are available on prescription only for example, the oral contraceptive pill (OCP) and long-acting reversible contraceptives (LARCs). In this analysis we aim to identify key determinants of prescription contraceptive use.

Design: Cross-sectional population survey. Data on sociodemographic indices, concerns about the OCP and perceived barriers to access were collected.

Setting: Data set constructed from a representative population-based telephone survey of community dwelling adults in the Republic of Ireland (RoI)

Participants: 1515 women aged between 18 and 45 years

Main outcome measure: Self-reported user of the OCP or LARCs (intrauterine contraception, contraceptive injections or subdermal contraceptive implants) in the previous 12 months.

Results: For at least some of the previous year, 35% had used the OCP and 14% had used LARCs, while 3% had used two or more of these methods. OCP users were significantly younger, more likely to be unmarried and had higher income than non-users. Overall, 68% agreed with the statement ‘that taking a break from long-term use of the contraceptive pill is a good idea’ and 37% agreed with the statement that ‘the OCP has dangerous side effects’ and this was the strongest predictor variable of non-use of the OCP. Intrauterine contraception users were significantly older, more likely to be married and had lower income than non-users. Injections or subdermal contraceptive implant users were significantly younger, less likely to be married, had lower income and were less likely to agree that taking a break from long-term use of the pill is a good idea than non-users.

Conclusions: Prescription contraceptive use is sociodemographically patterned, with LARCs in particular being associated with lower incomes in the RoI. Concerns about the safety of the OCP remain prevalent and are important and modifiable determinants of contraceptive-related behaviour.

Clinical assessment of ethinylestradiol and cyproterone acetate in menstrual irregularities of hyper-androgenic origin

We report on the results of a double-blind, randomized, controlled clinical trial comparing two preparations of ethinylestradiol and cyproterone acetate in the treatment of women of reproductive age presenting menstrual irregularities of hyper-androgenic origin. After obtaining informed consent, subjects were randomized to a 4-month treatment period consisting of one daily dose of 0.035mg ethinylestradiol + 2mg cyproterone acetate. The treatment regimen cycle consisted of one pill, once daily for 21 days, followed by a 7-day pill-free period. We compared the efficacy of two presentations of the drug combination after each treatment cycle (Visits 2, 3, 4, and 5) in establishment and maintenance of menstrual regulation, intensity of menstrual flow, and dysmenorrhea, as well as a comparison of the two presentations in terms of Global Satisfaction and Drug Satisfaction assessments performed by the patients and the investigating physician. At each study visit, drug compliance and use of concomitant medications, as well as incidence, severity and duration of adverse events were recorded. A total of 86 subjects were randomized to treatment, with 43 subjects in each treatment group. At Visit 2 and each subsequent visit, all patients in both treatment groups reported an episode of withdrawal bleeding during the 7-day hormone-free period. We observed a statistically significant (p<0.0001) decrease in the incidence of dysmenorrhea at each study visit in relation to the pretreatment assessment. There was a significant reduction (p<0.0001) in the number of subjects reporting intermenstrual bleeding at each study visit in both treatment groups. Global Satisfaction scores by the patient and physician increased significantly at each successive study visit in both treatment groups. There were no clinically significant changes in vital signs, weight, and body mass index throughout the study period in either group. The number of subjects reporting adverse events at each visit did not vary between treatment groups. The combined oral contraceptive pill containing ethinylestradiol and cyproterone acetate was found to be both effective and safe in the menstrual irregularities of hyper-androgenic origin (amenorrhea, dysmenorrhea, and intermenstrual bleeding) assessed in this study. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Ovulation and risk of epithelial ovarian cancer

Incessant ovulation is thought to be one of the primary causes of epithelial ovarian cancer. However, the effects of ovulation at different ages and of the various exposures or events that suppress ovulation have not been established. We used data from an Australian case-control study of 791 ovarian cancer cases and 853 controls to examine the effect of ovulation on ovarian cancer risk. The total number of lifetime ovulations was calculated using information provided in a monthly contraceptive/reproductive calendar, as well as incorporating other information such as average menstrual cycle length. An increase of I year's worth of ovulation was associated with a 6% increase in risk of ovarian cancer (95% confidence interval [CI] = 4-8%). Ovulations in the 20-29-year age group were associated with the greatest risk, with a 20% increase in risk associated with each year of ovulation during this age period (95% Cl = 13-26%). When the effects of different exposures that suppress ovulation were compared, there was an indication that some factors may have a greater effect than others. These findings support the theory that incessant ovulation is a major contributor to the occurrence of ovarian cancer and suggest that ovulations during the 20s may be those most associated with disease risk. (C) 2003 Wiley-Liss, Inc.

How does the health and well-being of young Australian vegetarian and semi-vegetarian women compare with non-vegetarians?

Objective: To compare the sociodemographic characteristics, health status and health service use of vegetarians, semi-vegetarians and non-vegetarians. Design: In cross-sectional data analyses of the Australian Longitudinal Study on Women's Health in 2000, 9113 women (aged 22-27 years) were defined as non-vegetarians if they reported including red meat in their diet., as semi-vegetarians if they excluded red meat and as vegetarians if they excluded meat, poultry and fish from their diet. Results: The estimated prevalence was 3% and 10% for vegetarian and semi-vegetarian young women. Compared with non-vegetarians, vegetarians and semi-vegetarians were more likely to live in urban areas and to not be married. Vegetarians and semi-vegetarians had lower body mass index (mean (95% confidence interval): 22.2 (21.7-22.7) and 23.0 (22.7-23.3) kg m(-2)) than non-vegetarians (23.7 (23.6-23.8) kg m(-2)) and tended to exercise more. Semi-vegetarians and vegetarians had poorer mental health, with 21-22% reporting depression compared with 15% of non-vegetarians (P < 0.001). Low iron levels and menstrual symptoms were also more common in both vegetarian groups. Vegetarian and semi-vegetarian women were more likely to consult alternative health practitioners and semi-vegetarians reported taking more prescription and non-prescription medications. Compared with non-vegetarians, semi-vegetarians were less likely and vegetarians much less likely to be taking the oral contraceptive pill. Conclusion: The levels of physical activity and body mass indices of the vegetarian and semi-vegetarian women suggest they are healthier than non-vegetarians. However, the greater reports of menstrual problems and the poorer mental health of these young women may be of clinical significance.

Steroid induced neuroprotection of damaged photoreceptor cells

Retinitis Pigmentosa (RP) is the name given to a group of hereditary diseases causing progressive and degenerative blindness. RP affects over 1 in 4000 individuals, making it the most prevalent inherited retinal disease worldwide, yet currently there is no cure. In 2011, our group released a paper detailing the protective effects of the synthetic progestin ‘Norgestrel’. A common component of the female oral contraceptive pill, Norgestrel was shown to protect against retinal cell death in two distinct mouse models of retinal degeneration: in the Balb/c light damage model and the Pde6brd10 (rd10) model. Little was known of the molecular workings of this compound however and thus this study aimed to elucidate the protective manner in which Norgestrel worked. To this aim, the 661W cone photoreceptor-like cell line and ex vivo retinal explanting was utilised. We found that Norgestrel induces a increase in neuroprotective basic fibroblast growth factor (bFGF) with subsequent downstream actions on the inhibition of glycogen synthase kinase 3β. Progesterone receptor expression was subsequently characterised in the C57 and rd10 retinas and in the 661W cell line. Norgestrel caused nuclear trafficking of progesterone receptor membrane complex one (PGRMC1) in 661W cells and thus Norgestrel was hypothesised to work primarily through the actions of PGRMC1. This trafficking was shown to be responsible for the critical upregulation of bFGF and PGRMC1- Norgestrel binding was proven to cause a neuroprotective bFGF-mediated increase in intracellular calcium. The protective properties of Norgestrel were further studied in the rd10 mouse model of retinitis pigmentosa. Using non-invasive diet supplementation (80mg/kg), we showed that Norgestrel gave significant retinal protection out to postnatal day 40 (P40). Overactive microglia have previously been shown to potentiate photoreceptor cell loss in the degenerating rd10 retina and thus we focussed on Norgestrel-mediated changes in photoreceptor-microglial crosstalk. Norgestrel acted to dampen pro-inflammatory microglial cell reactivity, decreasing chemokine (MCP1, MCP3, MIP-1α, MIP-1β) and subsequent damaging cytokine (TNFα, Il-1β) production. Critically, Norgestrel up-regulated photoreceptor-microglial, fractalkine-CX3CR1 signalling 1000-fold in the P20 rd10 mouse. Known to prevent microglial activation, we hypothesise that Norgestrel acts as a vital anti-inflammatory in the diseased retina, driving fractalkine-CX3CR1 signalling to delay retinal degeneration. This study stands to highlight some of the neuroprotective mechanisms utilised by Norgestrel in the prevention of photoreceptor cell death. We identify for the first time, not only a pro-survival pathway activated directly in photoreceptor cells, but also a Norgestreldriven mediation of an otherwise damaging microglial cell response. All taken, these results form the beginning of a case to bring Norgestrel to clinical trials, as a potential therapeutic for the treatment of RP.

Extended regimens of the contraceptive vaginal ring versus hormonal oral contraceptives: effects on lipid metabolism

Background: Combined oral contraceptives used in an extended regimen have been studied because of their potential benefits; however, there have been few publications on extended regimens of contraceptive vaginal rings. The aim of this study was to assess the effects of these two extended regimens on the lipid metabolism of women using these contraceptive methods during 1 year. Study Design: This prospective study enrolled 150 women: 75 used a vaginal contraceptive ring (11.7 mg etonogestrel and 2.7 mg ethinyl estradiol), and 75 used oral contraceptives (30 mcg ethinyl estradiol and 150 mg desogestrel). Both groups used their respective method for 84 days followed by a 7-day pause during I year. At baseline and every 3 months during the study period, blood was collected to assess total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and apolipoprotein (apo) A-I and B. The analysis of variance test was used to analyze differences in the results of these exams over time. Results: A total of 62 vaginal ring and 61 oral contraceptive users completed the study. There were no significant differences in the discontinuation rate, mean total cholesterol and fraction levels, apo B concentration or apo A-I/apo B ratio. Vaginal ring users had significantly higher apo A-I levels than oral contraceptive users. Conclusion: Despite the vaginal route of administration, the steroids released by the ring had the same effects on the lipid metabolism and lipoprotein levels typically seen with ethinyl estradiol given either by oral or parenteral routes. (C) 2012 Elsevier Inc. All rights reserved.

Contraceptive use and unintended pregnancy among 18-23 year old women in Australia : the first findings of the CUPID study

Objectives: Little is known about young adult women's experience of unintended pregnancy in Australia, nor the extent to which ineffective contraceptive use or contraceptive failure may lead to young women becoming pregnant. The CUPID study is the first in Australia to examine young adult Australian women's patterns of contraceptive use, their experience of unintended pregnancy, and their use (or not) of contraception at the time of conception. Methods: Australian women aged 18-23 years completed an online survey about contraceptive use and experience of unintended pregnancy. They were recruited through a range of methods including advertising on Facebook, and snowball sampling. Sample representativeness was established through comparison with Census data. Results: Of the 511 respondents, 403 women reported that they had ever had sex and were not currently pregnant. Among these women, the pill was the most common method of contraception used on the most recent occasion, used alone (30%) or with condoms (21%). Condoms (alone or with another method other than the pill) were used by a further 17%, and long-acting contraceptive methods by a further 16%. Other methods such as natural methods or partner vasectomy were used by 16%. The withdrawal method was surprisingly common and was mentioned by 15% of the women overall, usually in combination with another method. There were 63 women who had been pregnant, including 5 who were pregnant at the time of the survey, and of these 55 (87%) had become pregnant by accident. Of these 55 women, 69% reported using a range of contraception methods when they became pregnant by accident: Pill only (29%) and in combination with condoms (3%) and withdrawal (5%); condoms only (18%) and in combination with withdrawal (16%); emergency contraceptive pill only (3%) and in combination with withdrawal (3%) and withdrawal only (24%). Conclusions: This study highlighted the use of less effective methods of contraception among young Australian women. The withdrawal method was commonly used, often in combination with other methods, particularly before an unintended pregnancy. Among the women who had been pregnant, most reported that their pregnancy had been unintended. A third of the young women who had experienced an unintended pregnancy were using the withdrawal method. Further research is needed about the place of the withdrawal method in the contraceptive practices of young women.

Effects of dietary restraint and oral contraceptives on bone strength and bone turnover in young women

ABSTRACT Introduction The purpose of this study was to assess specific osteoporosis-related health behaviours and physiological outcomes including daily calcium intake, physical activity levels, bone strength, as assessed by quantitative ultrasound, and bone turnover among women between the ages of 18 and 25. Respective differences on relevant study variables, based on dietary restraint and oral contraceptive use were also examined. Methods One hundred women (20.6 ± 0.2 years of age) volunteered to participate in the study. Informed written consent was obtained by all subjects prior to participation. The study and all related procedures were approved by the Brock University Research Ethics Board. Body mass, height, relative body fat, as well as chest, waist and hip circumferences were measured using standard procedures. The 10-item restrained eating subscale of the Dutch Eating Behaviour Questionnaire (DEBQ) was used to assess dietary restraint (van Strien et al., 1986). Daily calcium intake was assessed by the Rapid Assessment Method (RAM) (Hertzler & Frary 1994). Weekly physical activity was documented by the 4-item Godin Leisure-Time Exercise Questionnaire (Godin & Shephard 1985). Bone strength was determined from the speed of sound (SOS) as measured by QUS (Sunlight 7000S). SOS measurements (m/s) were taken of the dominant and non-dominant sides of the distal one third of the radius and the mid-shaft of the tibia. Resting blood samples were collected from all subjects between 9am and 12pm, in order to evaluate the impact of lifestyle factors on biochemical markers of bone turnover. Blood was collected during the early follicular phase of the menstrual cycle (approximately days 1-5) for all subjects. Samples were centrifliged and the serum or plasma was aliquoted into separate tubes and stored at -80°C until analysis. The bone formation markers measured were Osteocalcin (OC), bone specific alkaline phosphatase (BAP) and 25-OH vitamin D. The bone resorption markers measured were the carboxy (CTx) and amino (NTx) terminal telopeptides of type-I collagen crosslinks. All markers were assessed by ELISA. Subjects were divided into high (HDR) and low dietary restrainers (LDR) based on the median DEBQ score, and also into users (BC) and non-users (nBC) of oral contraceptives. A series of multiple one way ANOVA's were then conducted to identify differences between each set of groups for all relevant variables. A two-way ANOVA analysis was used to explore significant interactions between dietary restraint and use of oral contraceptives while a univariate follow-up analysis was also performed when appropriate. Pearson Product Moment Correlations were used to determine relationships among study variables. Results HDR had significantly higher BMI, %BF and circumference measures but lower daily calcium intake than LDR. There were no significant differences in physical activity levels between HDR and LDR. No significant differences were found between BC and nBC in body composition, calcium intake and physical activity. HDR had significantly lower tibial SOS scores than LDR in both the dominant and non-dominant sites. The post-hoc analysis showed that within the non-birth control group, the HDR had significantly lower tibial SOS scores of bone strength when compared to the LDR but Aere were no significant differences found between the two dietary restraint groups for those currently on birth control. HDR had significantly lower levels of OC than LDR and the BC group had lower levels of BAP than the nBC group. Consistently, the follow-up analysis revealed that within those not on birth control, subjects who were classified as HDR had significantly (f*<0.05) lower levels of OC when compared with LDR but no significant differences were observed in bone turnover between the two dietary restraint groups for those currently on birth control. Physical activity was not correlated with SOS scores and bone turnover markers possibly due to the low physical activity variability in this group of women. Conclusion This is the first study to examine the effects of dietary restraint on bone strength and turnover among this population of women. The most important finding of this study was that bone strength and turnover are negatively influenced by dietary restraint independent of relative body fat. In general, the results of the present thesis suggest that dietary restraint, oral contraceptive use, as well as low daily calcium intake and low physical activity levels were widespread behaviours among this population of college-aged women. The young women who were using dietary restraint as a strategy to lose weight, and thus were in the HDR group, despite their higher relative body fat and weight, had lower scores of bone strength and lower levels of markers of bone turnover compared to the low dietary restrainers. Additionally, bone turnover seemed to be negatively affected by oral contraceptives, while bone strength, as assessed by QUS, seemed unaffected by their use in this population of young women. Physical activity (weekly energy expenditure), on the other hand, was not associated with either bone strength or bone tiimover possibly due to the low variability of this variable in this population of young Canadian women.

Densidade mineral óssea em adolescentes usuárias de anticoncepcional oral combinado

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Sensibilidade à pressão e atividade elétrica dos músculos temporal e masseter durante o ciclo menstrual de mulheres que fazem e não o uso contraceptivo oral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Evaluation of silent period on masticatory cycles of different muscles in dentate oral contraceptives users and nonusers

The aim of this study was to evaluate the influence of oral contraceptive use on the silent period (SP) of anterior temporal and masseter muscles during the menstrual cycle. Totally, 28 women on reproductive age were selected including 15 nonusers of any hormone and 13 contraceptive users. All patients were dentate without muscular temporomandibular disorders. Electromyography (SP test) of the anterior temporal and masseter muscles was conducted every week during three consecutive menstrual cycles at 1(st) day of menstruation (P1), 7(th) day (P2), 14(th) day (P3) and 21(st) day (P4). The SP values in the anterior temporal and masseter muscles were measured at both sides. The SP values of the right side (13.49 ms) at P2 were significantly different compared to the left side (12.28 ms). However, there was no significant difference on the interactions among the three factors. It can be concluded that the SP values in healthy women in reproductive age may not be influenced by the menstrual cycle with similar results for both muscles.

Electrical activities and pressure pain threshold in oral contraceptives users and nonusers

The aim is to evaluate the influence of oral contraceptive intake and menstrual cycle on the electrical activity and pressure pain threshold from anterior temporal and masseter muscles. Twenty-eight women on reproductive age were selected, 13 OC users and 15 nonusers. They were weekly submitted to electromyography and algometry of the anterior temporal and masseter muscles during three consecutive menstrual cycles. Electrical activities at rest position and PPTs of temporal and masseter muscles were not affected by menstrual cycle or by OCs uses. Comparison between groups demonstrated that working side electrical activity was increased in OC users in both muscles, except during lutheal phase for the anterior temporal. However, comparison within weeks did not demonstrate statistical difference. It was suggested that, in healthy women, oral contraceptive use may influence electrical activity, but different phases of the cycle may not.

PS-042c is low-dose combined oral contraceptives use associated to lower bone mineral content variation in adolescents over a one-year period?

Background Low dose combined oral contraceptives (COC) can interfere in bone mass acquisition during adolescence. To evaluate bone mineral density (BMD) and bone mineral content (BMC) in female adolescents taking a standard low-dose (EE 20 µg/Desogestrel 150 µg) combination oral contraceptive (COC) over a one-year period and compare with healthy adolescents from the same age group not taking COCs.Methods A non-randomised parallel control study with one-year follow-up. Sixty-seven adolescents from 12 to 20 years of age, divided into COC users (n = 41) taking 20 µg EE/150 µg Desogestrel and non-user controls (n = 26), were evaluated through bone densitometry examinations at baseline and 12 months later. Comparisons between groups at study start was done through the Mann-Whitney test with significance level fixed at 5% or corresponding p value; comparisons between groups at study start and 12 months later used variations in median percentages for bone mass variables.Results COC users presented low bone mass acquisition in the lumbar spine and BMD and BMC median variations between baseline and at 12 months of 2.07% and +1.57% respectively whereas the control group presented variations of +12.16% and +16.84% for BMD and BMC, respectively, over the same period. The total body BMD and BMC presented similar evolution during the study in both groups. Statistical significance (pConclusion The use of a low COC dose (EE 20 µg/Desogestrel 150 µg) was associated to lower bone mass acquisition in adolescents during the study period.Trial registration: (Register Number):RBR-5 h9b3c