Attributable Causes of Breast Cancer and Ovarian Cancer in China:Reproductive Factors,Oral Contraceptives and Hormone Replacement Therapy

Objective： To provide an evidence-based, consistent assessment of the burden of breast cancer attributable to reproductive factors （RFs, including nulliparity, mean number of children, age at first birth and breastfeeding）, use of oral contraceptives （OCs, restricted to the age group of 15-49 years）, and hormone replacement therapy （HRT）, as well as of the burden of ovarian cancer attributable to the mean number of children in China in 2005. Methods： We derived the prevalence of these risk factors and the relative risk of breast and ovarian cancer from national surveys or large-scale studies conducted in China. In the case of RFs, we compared the exposure distributions in 2001 and counterfactual exposure. Results： Exposure of RFs in 2002 was found to account for 6.74% of breast cancer, corresponding to 9,617 cases and 2,769 deaths, and for 2.78% of ovarian cancer （712 cases, 294 deaths）. The decrease in mean number of children alone was responsible for 1.47% of breast cancer and 2.78% of ovarian cancer. The prevalence of OC use was 1.74% and the population attributable fraction （PAF） of breast cancer was 0.71%, corresponding to 310 cases and 90 deaths. The PAF of breast cancer due to HRT was 0.31%, resulting in 297 cases and 85 deaths. Conclusion： RFs changes in China contributed to a sizable fraction of breast and ovarian cancer incidence and mortality, whereas HRT and OCs accounted for relatively low incidence of breast cancer in China.

The impact of combined oral contraceptives on ocular tissues:a review of ocular effects

The aim of this manuscript is to review the action and adverse effects of combined oral contraceptives（COCs）on ocular tissues.The percentage of unwanted pregnancies and the subsequent abortions make contraception crucial worldwide.Over 100 million women around the world use common contraceptive methods,including intrauterine devices,combined estrogen and progestin oral contraceptives,as well as progestin only preparations（oral contraceptives,implants or injections）.COCs are widely used for contraception,but they are also indicated in menorrhagia,endometriosis,acne and hirsutism,fibroid uterus and premenstrual syndrome.However,they have been associated with high rates of cardiovascular events,venous thromboembolic disease,ischemic strokes and breast cancer.The incidence of COCs-related ocular complications is estimated to be 1 in 230 000,including dry eye symptoms,corneal edema,lens opacities and retinal neuro-ophthalmologic or vascular complications.We may infer that the serious ocular complications of COCs can be prevented by eliminating the estrogen dosage and choosing third-generation progestins.In any case,doctors should take into consideration the systemic and ocular history of the patients before selecting any method of contraception.

Use of oral contraceptives and risk of pancreatic cancer in women:A recalculated meta-analysis of prospective cohort studies

In a recent systematic review and meta-analysis of observational studies,the author found potential errors in the selection and extraction processes.The recalculated summary relative risks and the results of a dose-response metaanalysis showed that oral contraceptive use may not be associated with the risk of pancreatic cancer in women.

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.

Relieving the Impacts of Oral Contraceptives on Lipids Profile by Taking Pills in a Novel Scheme

Objective To explore whether the changes on lipids profile induced by oral contraceptives could be reduced through alternatively administering two oral contraceptives of different formulations (either predominant in progestogen or estrogen) Materials &. Methods A total of 59 women aged 25- 45 were divided into two treatment groups.The subjects in Group A received oral contraceptive A (Oc A: NET 0. 600 mg + EE 0. 035 mg) and B (OcB: LNG 0. 15mg + EEO. 03 mg) alternatively during 12 treatment cycles. Each contraceptive was administrated for three cycles consecutively with starting from OcA. The subjects in the B group received OcB only during 12 treatment cycles. Fasting blood were drawn before treatment, at the end of each trimester treatment and at the end of one cycle after stopping treatment respectively. The concentrations of lipids and apolipoproteins were measured.Results OcA increased the levels of triglyceride(TG) , total cholesterol (TC), high density lipoprotein-cholesterol(HDL-c) , and apolipoprotein AI (apo AI) with statistical significance, whereas OcB significantly decreased all parameters above. As compared with the control group, the overall mean of variation in the study group was much less than that of the control group.Conclusion It indicates that the impacts of oral contraceptives on lipids profile could be moderated by means of alternatively administering Ocs of two different formulations , with estrogen-dominant or progestogen-dominant.

Hepatic Adenoma Secondary to Long-Term Oral Contraception Use in a Young Female

Hepatic adenomas are a rare byproduct of oral contraceptive pill (OCP) use. Laboratory workup is often inconclusive. Diagnosis can be made via MRI;however, select cases may require further testing such as fine needle aspiration or core needle biopsy. We report a case of a 36-year-old female who was referred to gastroenterology for further evaluation of several liver lesions found incidentally on imaging. Due to risk factors, such as age, long-term oral contraceptive use and obesity, adenoma was high on the differential. Although infrequent, this case emphasizes the importance of a detailed history, including medication review, and physical examination.

Comparison of Drospirenone-with Cyproterone Acetate-Containing Oral Contraceptives, Combined with Metformin and Lifestyle Modifications in Women with Polycystic Ovary Syndrome and Metabolic Disorders： A Prospective Randomized Control Trial

Background：While combined oral contraceptives （COCs） are commonly used to treat polycystic ovary syndrome （PCOS）,comparative data regarding metabolic effects of different progestogens on this patient population are missing.This study aimed to compare the different effects of drospirenone （DRP）-containing COCs with cyproterone acetate （CPA）-containing COCs,combined with metformin and lifestyle modifications in women with PCOS and metabolic disorders.Methods：Ninety-nine women with PCOS and a metabolic disorder between January 2011 and January 2013 were enrolled into this prospective randomized clinical trial.Participants were randomized into two groups such as DRP-containing COCs,and CPA-containing COCs.Participants took COCs cyclically for 6 months,combined with metformin administration （1.5 g/d） and lifestyle modifications （diet and exercise）.Clinical measures and biochemical and hormone profiles were compared.Comparisons for continuous variables were evaluated with paired and unpaired Student＆#39;s t-tests.The Wilcoxon signed rank test was used when the data were not normally distributed.Analysis of covariance was used to control for age,body mass index （BMI）,and baseline data of each analyzed parameter when compared between the two groups.Results：A total of 68 patients have completed the study.The combination regimen of COCs,metformin,and lifestyle modifications in these patients resulted in a significant decrease in BMI,acne,and hirsutism scores when compared to baseline levels in both groups （P 〈 0.05）.Blood pressure （BP） was significantly different in the CPA group when compared to baseline （75.14 ± 6.77 mmHg vs.80.70 ± 5.60 mmHg,P 〈 0.01）,and after 6 months of treatment,only the change in systolic BP was significantly different between the two groups （4.00 [-6.00,13.00] mmHg vs.-3.50 [-13.00,9.00] mmHg,P =0.009）.Fasting glucose,fasting insulin,and homeostasis model assessment-insulin resistance decreased significantly in the DRP group （5.40 ± 0.41 mmol/L vs.5.21 ± 0.32 mmol/L,P =0.041;13.90 [10.50,18.40] μU/ml vs.10.75 [8.60,13.50] μU/ml,P =0.020;3.74 [2.85,4.23] vs.2.55 [1.92,3.40],P =0.008） but did not differ between the two groups.While individual lipid profiles increased in both groups,no statistically significant difference was observed.Conclusions：DRP-containing COCs combined with metformin and lifestyle modifications could better control BP and correct carbohydrate metabolism in women with PCOS and metabolic disorders compared with CPA-containing COCs.

Effect of Two Kinds of Different Combined Oral Contraceptives Used on Bone Mineral Density in Women of Reproductive Age

Objective To compare bone mineral density （BMD） among users of ethinylestradiol/ desogestrel, ethinylestradiol/cyproterone acetate and nonhormonal control subjects. Methods The study included 154 women aged 25-40 years. Forty-six women were using ethinylestradiol/desogestrel （group A） and 55 women using ethinylestradiol/cyproterone acetate （group B）for 24 months and 53 women using nonhormonal contraception as control subjects （group C）. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry, comparing mean BMD changes in combined oral contraceptives （COCs） users with nonusers. Results For 24 months of treatment, lumbar spine and femoral neck BMD values in women who used ethinylestradiol/desogestrel and ethinylestradiol/cyproterone acetate were not significantly different compared with the baseline and the values of subjects in nonuser （P〉0.05）. Conclusion There was no statistical difference in BMD between the users of ethinylestradiol/desogestrel or ethinylestradiol/cyproterone acetate and nonusers.

Two cases of venous sinus thrombosis in women taking the oral contraceptive pill, Yaz (dropirenone/ ethinyl estradiol), and review of the literature

Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke and the clinical presentation is variable, thus mimicking other neurologic pathologies. One of the more common acquired risk factors of venous sinus thrombosis is oral contraceptive medications such as Yaz. While the prognosis for CVT is favorable, it is important to identify and treat early to prevent neurologic deficits. We report two cases of young female patients who presented with sinus thrombosis and review the current literature on this topic. CVT accounts for 0.5% of strokes and most commonly presents with headaches and in many cases focal neurologic deficits. Diagnosis is confirmed with neuroimaging including CT angiography or MR angiography. Treatment consists of anticoagulation and in some cases, thrombolytic therapy is beneficial. The overall prognosis of CVT is favorable but, further research is needed to outline optimal treatment options including the duration of anticoagulation therapy and the role of thrombolytic therapy to prevent serious neurologic deficits.

Association between oral contraceptive use and pancreatic cancer risk:A systematic review and meta-analysis

BACKGROUND Studies on the association of oral contraceptive(OC)use and pancreatic cancer showed inconsistent findings.AIM To evaluate the relationship between OC use and pancreatic cancer risk.METHODS A literature search for observational studies(case-control and cohort studies)was conducted up to December 2020.A meta-analysis was performed by calculating pooled relative risks(RRs)and 95%confidence intervals(CIs).Heterogeneity was assessed using Cochran’s chi-square test and I2 statistic.Subgroup analyses were performed by study design,source of controls in case-control studies,number of cases of pancreatic cancers,study quality according to Newcastle-Ottawa Scale score,geographical region and menopausal status.All analyses were performed using Review Manager 5.3(RevMan 5.3).RESULTS A total of 21 studies(10 case-control studies and 11 cohort studies)were finally included in the present meta-analysis,comprising 7700 cases of pancreatic cancer in total.A significant association was observed between the ever use of OC and pancreatic cancer risk in the overall analysis(RR=0.85;95%CI=0.73-0.98;P=0.03).Duration of OC use(<1 year,<5 years,5-10 years,>10 years)was not significantly associated with the risk of pancreatic cancer.Subgroup analyses revealed a statistically significant subgroup difference for the geographic region in which the study was conducted(Europe vs Americas vs Asia;P=0.07).Subgroup analyses showed a statistically significant decrease in pancreatic cancer risk and OC use in high-quality studies,studies conducted in Europe,and in postmenopausal women.CONCLUSION Despite the suggested protective effects of OC use in this meta-analysis,further epidemiological studies are warranted to fully elucidate the association between the use of OC and pancreatic cancer risk.

Combined Oral Contraceptive Use at the University of Port Harcourt Teaching Hospital, Port Harcourt, Southern Nigeria: A-20 Year Review

Background: While the combined oral contraceptive pill (COCP) is one of the most commonly used methods of birth control especially in the developed countries, robust and current information on the pill use in developing countries including Nigeria is at best lacking. Objectives: The study was conducted to determine the prevalence rate, efficacy and side effects of COCP at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Southern Nigeria. Methods: It was a retrospective analysis of all clients who used the COCP between 1st January 1997 and 31st December, 2016, at the family planning clinic of UPTH Port Harcourt. Data on sociodemographic profile, side effects and source of information were extracted from the clients’ case notes coded and fed into Excel spread sheet and analysed. Results: Of the 8310 new acceptors of modern contraceptive methods in UPTH, 399 clients used the COCP, giving a prevalence rate of 4.8%. The mean age of the acceptors was 26.42 ± 4.27 years while the mean parity was 1.90 ± 0.36. Menstrual disruption was the most common complications with 78 episodes constituting 47.0% of all the complications. One unintended pregnancy occurred during the period of observation, giving a Pearl index of 0.01. Conclusion: The study showed that although COCP is very effective, readily available, safe and reliable method of fertility control, the acceptance rate is very low and the patronage rapidly declining and may therefore go into extinction as a family planning method in Port Harcourt, Southern, Nigeria.

A drospirenone-containing oral contraceptive improved bleeding pattern and personal satisfaction in 914 women from Jordan, Lebanon and Syria

Aim: We assessed bleeding pattern, tolerance and patient satisfaction of an oral contraceptive containing 3 mg drospirenone and 30 mcg ethinyl estradiol (DRSP/EE) under real-life conditions. Study Design: We performed a multicenter, prospective, 6-cycle, observational study in Canada, Europe and the Middle East. Detailed analyses of the three Middle East countries, Jordan, Lebanon andSyriawere presented here. The efficacy variables included an assessment of bleeding patterns, premenstrual symptoms of water retention and patient satisfaction, as determined by a visual analogue scale. Results: A total of 914 women were enrolled. The percentage of women with intermenstrual bleeding decreased from 37.4%, 48.7% and 32.2% at baseline to 9.7%, 6.1% and 10.9% at the end of cycle6 inJordan, Lebanon and Syria, respectively (creased sharply in all three countries (p Amenorrhea decreased significantly in Lebanon and Syria (p < 0.005). In addition, signs of water retention like abdominal bloating, breast tenderness and swelling of extremities decreased significantly over the course of 6 treatment cycles (p < 0.001). Patient satisfaction increased for all investigated items. Upon completion of the study, 82.7% of women answered “Yes” to continue treatment with this oral contraceptive. Conclusion: The oral contraceptive containing 3 mg drospirenone and 30 mcg ethinyl estradiol has beneficial effects on bleeding pattern, symptoms of water retention and patient satisfaction.

A multivariate analysis of the factors that influence the modification of sexual desire in oral hormonal contraceptive (OC) users

Objective. This work studied the influencing factors of age, level of education, family planning awareness, relationship with partner, the age at which sexual relationships were initiated, parity, the method of contraceptive previously used, the type of contraceptive pill used and the duration of oral hormonal contraception (OC) use in relation to the modification of sexual desire in OC users. Materials and Methods. Prospective study of 760 OC users at the Family Planning Center “Marina Alta” in Alicante (Spain). A logistical regression analysis was carried out to study the relative risk of reduction in libido, taking other risk factors into account. Results. In the simple analysis, women who initiated sexual relationships between 18 and 25 years of age had a lower sexual desire in comparison with women who were sexually active before the age of 18 (OR = 2.11;CI: 1.15 - 3.91). Nulliparous women had a reduced sexual desire compared with those women that had given birth (OR = 2.32;CI: 1.41 - 3.82). An OC use of between 6 months and 1 year reduced sexual desire in comparison with a use of less than 6 months (OR = 0.24;CI: 0.09 - 0.64). In the multivariate analysis, age (OR = 1.12;CI: 1.01 - 1.21) and the use of OC within an initial 6 month to a year period (OR = 0.24;CI: 0.09 - 0.64) presented a statistically significant relationship with the modification of sexual desire. The level of education, family planning awareness, relationship with partner, the method of contraception previously used and the type of contraceptive pill prescribed showed no statistical significance with the modification of sexual desire in OC users. Conclusions. Sexual desire in OC users decreases as a woman’s age increases and in an early stage of use in the first six months after beginning OC treatment.

Effective Treatment of Vulvar-Vaginal Complaints in Women Taking Combined Oral Contraceptive with a New Medical Device in Gel: A Pilot Study

Objective: To assess efficacy and tolerability of a new medical device in gel based on the synergic combination of NioskinTM Red Clover Extract noisome (NRC) and SylTechTM system (SB), a complex of silicium microcrystals covalently bound with silver ions associated with hyaluronic acid to the treatment of vulvo-vaginal dryness and dyspareunia in women taking combined oral contraceptive (COC). Methods: Forty eight women were treated for 12 weeks with NRC + SB vaginal gel (0.75 g/day) for 3 weeks. After therapy, symptoms (dyspareunia and dryness) were evaluated through a 10-cm VAS. Visual examination of the vagina and vulvar vestibule was also conducted, which included observations for petechiae, pallor, friability, dryness, and redness in the mucosa. Ratings were based on a 4-point scale (0, none;1, mild;2, moderate;3, severe). Results: NRC + SB vaginal gel appears to be effective for relief vulvo-vagianl dryness and dyspareunia and an improvement of vaginal and vestibular trophism was noted. Conclusion: NRC + SB vaginal gel proved good treatment options for relief of vulvovaginal symptoms in women who take COC.

Acute mesenteric ischemia secondary to oral contraceptive-induced portomesenteric and splenic vein thrombosis:A case report

BACKGROUND Mesenteric ischemia represents an uncommon complication of splanchnic vein thrombosis,and it is less infrequently seen in young women using oral contraceptives.Diagnosis is often delayed in the emergency room;thus,surgical intervention may be inevitable and the absence of thrombus regression or collateral circulation may lead to further postoperative ischemia and a fatal outcome.CASE SUMMARY We report a 28-year-old female patient on oral contraceptives who presented with acute abdominal pain.Her physical examination findings were not consistent with her symptoms of severe pain and abdominal distention.These findings and her abnormal blood tests raised suspicion of acute mesenteric ischemia(AMI)induced by splanchnic vein thrombosis.Contrast-enhanced abdominal computed tomography revealed ischemia of the small intestine with portomesenteric and splenic vein thrombosis(PMSVT).We treated the case promptly by anticoagulation after diagnosis.We then performed delayed segmental bowel resection after thrombus regression and established collateral circulation guided by collaboration with a multidisciplinary team.The patient had an uneventful postoperative course and was discharged 14 d after surgery and took rivaroxaban orally for 6 mo.In subsequent follow-up to date,the patient has not complained of any other discomfort.CONCLUSION AMI induced by PMSVT should be considered in young women who are taking oral contraceptives and have acute abdominal pain.Prompt anticoagulation followed by surgery is an effective treatment strategy.

利用两样本孟德尔随机化方法探究复方口服避孕药与乳腺癌发病风险的关系

目的:利用两样本孟德尔随机化方法探究评估抗复方口服避孕药(combined oral contraceptive,COC)对乳腺癌风险的影响。方法:对基于与COC高度相关的单核苷酸多态性的全基因组关联研究的合并数据进行二次数据分析,并选择雌激素和孕激素水平作为工具变量,分别采用逆方差加权、MR-Egger回归和加权中位数方法进行两样本孟德尔随机化分析,以评估COC、雌激素及孕激素与乳腺癌和ER^(+)/ER^(-)乳腺癌之间的关联。我们分别采用逆方差加权、MR-Egger回归和加权中位数方法进行两样本孟德尔随机化分析。最后进行敏感性分析来评估结果的稳定性和可靠性。结果:逆方差加权、MR-Egger回归和加权中位数方法三种方法均显示COC的使用与乳腺癌(包括ER^(+)/ER^(-)乳腺癌)的发生无显著风险关联(P均>0.05)。结论:孟德尔随机化结果显示COC的使用与乳腺癌发病风险之间无关。

优思明致缺血性肠病:1例报道

通过介绍1例罕见的优思明所致缺血性肠病患者的诊疗情况,增加临床医师对口服避孕药不良反应的认识,提醒临床医师加强对口服避孕药女性的宣教及接诊女性肠病患者时对用药史的关注。

依托孕烯植入剂对子宫肌瘤患者避孕价值的研究

目的评估依托孕烯植入剂在子宫肌瘤患者中避孕的安全性及可行性。方法选择2021年1月—2022年3月上海市嘉定区妇幼保健院就诊有避孕需求且合并子宫肌瘤的育龄期女性90例,依据使用不同的避孕措施,分为A组(依托孕烯植入剂)、B组(避孕套)和C组(口服屈螺酮炔雌醇片),每组各30例,分别记录不同避孕方式后的3、6、12个月时子宫肌瘤体积大小、血雌孕激素水平变化、避孕措施的脱落率、避孕有效率、不良反应发生率、患者满意度。结果三组受试者在子宫肌瘤体积大小、脱落率、避孕有效率方面差异均无明显统计学意义(P>0.05);三组受试者在应用上述避孕措施3个月后雌激素水平比较,差异无统计学意义(P>0.05),但在应用6个月及12个月后差异均有统计学意义(P<0.05);三组受试者在应用上述避孕措施3、6、12个月后孕激素水平比较,差异均有统计学意义(P<0.05);三组不良反应比较:与B组比较,A组和C组主要表现为月经模式的改变(P<0.05),在体重变化、白带改变、痤疮、乳房胀痛、性欲减退、应用过敏不适等方面,组间比较差异无统计学意义(P>0.05);三种避孕方式中,A组满意度最高。结论对于子宫肌瘤患者,若使用依托孕烯避孕,不仅避孕有效率高,副反应及并发症少,雌孕激素波动范围小,患者满意度高,且肌瘤在应用期间无明显增长,值得临床医生在子宫肌瘤患者中推广应用。

DNG和COC用于卵巢子宫内膜异位囊肿剥除术后控制复发的疗效比较

目的比较地诺孕素(DNG)和复方口服避孕药(COC)用于卵巢子宫内膜异位囊肿剥除术后长期管理的疗效。方法选取2020年2月至2021年8月在湖北省妇幼保健院行腹腔镜卵巢子宫内膜异位囊肿剥除术的58例患者作为研究对象,术后给予促性腺激素释放激素激动剂(GnRH-a)治疗3个月。采用随机数字表法将研究对象分为DNG组(n=28)和COC组(n=30),分别服用DNG和COC 12个月。比较两组痛经视觉模拟评分法(VAS)评分、血清糖类抗原125(CA125)、雌二醇(E_(2))、抗米勒管激素(AMH)、囊肿复发情况、月经模式、骨密度(BMD)、不良反应及成本-效果比(C/E)。结果两组痛经VAS评分、CA125、AMH比较,差异无统计学意义(P>0.05);DNG组E_(2)、股骨及腰椎BMD高于COC组(P<0.05);两组均无囊肿复发;两组不良反应总发生率比较,差异无统计学意义(P>0.05);COC组C/E低于DNG组(P<0.05)。结论DNG控制卵巢子宫内膜异位囊肿剥除术后复发的效果与COC相当,但对BMD和E_(2)的影响可能小于COC,但价格高于COC。

维生素AD联合铁剂治疗婴幼儿缺铁性贫血的效果

目的:观察维生素AD滴剂联合蛋白琥珀酸铁口服液治疗婴幼儿缺铁性贫血的临床效果。方法:选取安徽省庐江县人民医院儿童保健门诊缺铁性贫血患儿102例,性别不限,采用随机数字表法分为观察组(n=52)和对照组(n=50)。观察组治疗采用蛋白琥珀酸铁口服液联合维生素AD滴剂口服,对照组治疗仅采用蛋白琥珀酸铁口服液口服。治疗前分析缺铁性贫血患儿维生素A和25-羟维生素D缺乏情况,于治疗1个月后对2组治疗效果进行比较并对贫血相关指标进行分析。结果:治疗前两组缺铁性贫血患儿维生素A和25-羟维生素D缺乏严重。治疗后,观察组的显效率为61.54%,明显高于对照组的44%(P<0.05);总有效率为94.23%,也明显高于对照组的84%(P<0.05);观察组血红蛋白、血清铁和血清铁蛋白较对照组明显改善(P<0.05)。结论:维生素AD滴剂联合蛋白琥珀酸铁口服液用于婴幼儿缺铁性贫血治疗时可有效改善患儿相关的贫血指标,显著提高临床治疗效果。