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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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。

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.

Balancing Dermatological and Gynecological Considerations: Evaluating the Necessity of Pelvic Exams in OCP Prescriptions for Acne Management

Routine pelvic examinations in women prescribed oral contraceptive pills (OCPs) for acne management are scrutinized to assess their impact on dermatological outcomes versus gynecological health. A synthesis of clinical trials, patient surveys, and medical guidelines reveals that these routine exams do not significantly enhance the effectiveness of acne treatment with OCPs but are linked to increased patient discomfort and false-positive results. Evidence suggests that routine pelvic examinations do not significantly impact the effectiveness of acne management with OCPs but are associated with increased patient discomfort and higher rates of false-positive results. The analysis indicates that a more personalized approach, focusing on selective pelvic examinations based on individual risk factors and clinical symptoms, may offer a more practical and patient-centered alternative. The review advocates for a reexamination of existing guidelines to better align with a model of individualized care, emphasizing the need for further research to optimize best practices at the intersection of dermatological and gynecological care. Adopting a personalized approach to pelvic examinations could substantially improve patient care by minimizing unnecessary interventions and discomfort while maintaining the efficacy of acne treatment with oral contraceptive pills.

Non-viral causes of hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is the most common primary liver malignancy and represents an international public health concern as one of the most deadly cancers worldwide.The main etiology of HCC is chronic infection with hepatitis B and hepatitis C viruses.However,there are other important factors that contribute to the international burden of HCC.Among these are obesity,diabetes,non-alcoholic steatohepatitis and dietary exposures.Emerging evidence suggests that the etiology of many cases of HCC is in fact multifactorial,encompassing infectious etiologies,comorbid conditions and environmental exposures.Clarification of relevant non-viral causes of HCC will aid in preventative efforts to curb the rising incidence of this disease.

Complete spontaneous regression of giant focal nodular hyperplasia of the liver: Magnetic resonance imaging evaluation with hepatobiliary contrast media

Focal nodular hyperplasia(FNH) of the liver is a benign lesion occurring in 0.6%-3% of the general population that probably reflects a local hyperplastic response of hepatocytes to a vascular abnormality. Most lesions are diagnosed incidentally and the natural history of the disease remains largely unknown. It has been shown that most FNH remain stable, or even regress, over a long follow-up period. We present a patient with FNH of the liver who was followed up for 7 years. A 26-yearold woman with a 5-year history of oral contraceptive use was referred to our hospital in February 2005 for further examination of a liver tumour. The diagnosis of FNH was made using magnetic resonance(MR) imaging with hepatospecific contrast media; this technique allows a correct diagnosis, in particular distinguishing FNH from hepatic adenoma, avoiding an invasive procedure such as the lesion biopsy. After 7-year from the diagnosis, we observed the complete spontaneous regression of the lesion by enhanced MR scanning. In this patient, discontinuation of oral contraceptive use and two childbirths may have influenced the natural history of FNH. To our knowledge, in the English literature there is no report illustrating a complete regression of giant FNH but only studies of decreasing in size. The present case suggests that a young patient with giant FNH should be managed conservatively rather than by resection, because FNH has the potential for spontaneous regression.

Obesity is associated with colitis in women but not necessarily causal relationship

The relationship between obesity and female risk of microscopic colitis remains to be discussed.

25岁以下未育女性人工流产后即时落实宫内节育器和短效口服避孕药的临床对照观察

目的:观察25岁以下未育女性人工流产后即时放置宫内节育器(IUD)和使用短效复方口服避孕药(COC)的可行性和使用情况。方法:将≤25岁未育早孕自愿要求人工流产的女性作为观察对象,根据其意愿术后放置IUD或使用COC避孕。IUD组148例,COC组204例,随访6个月观察两组的避孕情况。结果:两组均无妊娠发生。IUD组1例因完全脱落而终止使用,终止率为0.7%。COC组术后3月的累积停用率69.1%,6月达92.1%,停用的主要原因是嫌麻烦/不能坚持服药,占31.4%。术后1,3个月的不适主诉率IUD组高于COC组(P<0.010,P<0.001)。结论:≤25岁未育女性人工流产后即时放置IUD或使用COC避孕均可行高效。IUD组6个月续用率高;COC副作用轻,但需加强咨询,提高续用率。

颏下岛状瓣在口腔癌根治术后软组织缺损修复中的应用价值

目的探讨颏下岛状瓣(SMIF)在口腔癌(OC)根治术后软组织缺损修复中的应用价值。方法选取100例OC根治术后软组织缺损患者,按随机数字表法分为对照组(50例)与观察组(50例)。对照组实施吻合血管游离前臂皮瓣修复,观察组实施SMIF修复,两组患者均观察到术后3个月。对比两组手术相关指标、口腔开口度、吞咽与咀嚼功能、生活质量、并发症。结果观察组术中出血量[(242.84±12.78)ml]少于对照组[(326.75±14.69)ml],手术与住院时间[(356.93±16.27)min、(13.29±2.82)d]短于对照组[(448.65±17.84)min、(17.48±3.46)d],而并发症发生率[6.00%(3/50)]低于对照组[20.00%(10/50)],有统计学差异(P<0.05);术前、术后,两组口腔开口度、吞咽与咀嚼功能、生活质量综合评定问卷(GQOLI-74)内的各维度评分相比,无统计学差异(P>0.05);但术后,两组口腔开口度、吞咽与咀嚼功能与GQOLI-74内各项维度的评分均较术前高,有统计学差异(P<0.05)。结论SMIF与吻合血管游离前臂皮瓣修复均能够有效改善OC根治术后软组织缺损患者口腔开口度,提高其吞咽与咀嚼功能、生活质量,但SMIF修复具备出血量更低、手术及住院时间更短、并发症更少优点,值得临床大力推行。