Special Considerations in the Management of Women with Epilepsy in Reproductive Years

Anti-seizure medications (ASMs) fail to prevent seizure recurrence in more than 30% of patients with epilepsy. The treatment is more difficult in premenopausal women with epilepsy (WWE) because changes in plasma estrogen and progesterone concentrations during the menstrual cycle often affect seizure frequency and intensity. Interactions between enzyme-inducin ASMs and hormonal contraceptives can lead to both a loss of seizure control and failure of contraception. Significant changes in the function of the liver and kidneys during pregnancy can accelerate metabolism and elimination of ASMs, causing breakthrough seizures. In addition, the teratogenic, cognitive, and psychological effects of ASMs on potential offspring have to be considered when choosing the best ASM regimen. Therefore, aspecialized approach is necessary for the treatment of premenopausal WWE.

Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study

Background Multiple contraindications to combined hormonal contraceptives (CHC) use exist. The impact of these factors on contraceptive choice, particularly among women living with HIV (WLWH), is not well understood. We measured and compared the prevalence of contraceptive use and contraindications among WLWH and women not living with HIV (controls). Methods We examined cross-sectional survey and medical chart data from 83 WLWH and 62 controls, aged 16–49 and sexually active, from 2013–2017. We compared the age-adjusted prevalence and types of contraceptives used in the last month and the proportion of women with CHC contraindications, including drug interactions, medical comorbidities, and smoking at ≥ 35 years old. All WLWH received care at an interdisciplinary, women-centred HIV clinic. Results Compared to controls, WLWH were older (median [IQR)] 39 [34–43] vs 31 [23–41] years; p = 0.003), had less post-secondary education (37% vs 73%; p < 0.001), and more often had household income < $15,000/year (49% vs 30%; p = 0.006). WLWH trended to higher contraceptive prevalence than controls (80% vs 63%; p = 0.06 adjusted for age). Overall hormonal contraceptive use was similar. However, despite controlling for age, WLWH used CHC less (4% vs 18%; p = 0.006) than controls, and had more frequently undergone tubal ligation (12% vs 2%; p = 0.03). WLWH also experienced more CHC contraindications (54% vs 13%; p = 0.0001), including smoking at ≥ 35 years old (30% vs 6%; p = 0.0003) or a CHC-related drug interaction (all antiretroviral related) (25% vs 0%; p = 0.0001). Conclusions WLWH attending our interdisciplinary clinic used hormonal contraception at similar rates as controls, though with different types. Differences may reflect different distributions of CHC contraindications. CHC contraindications present barriers to accessing the full range of contraceptive choices for WLWH. Guidelines and education for care providers and WLWH regarding contraceptive choices and drug interactions are needed, especially when care is provided without the benefit of an interdisciplinary women-centered healthcare team.

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.

The effect of hormonal contraceptive on low birth weight baby delivery in Agronursing Area

Babies born with low birth weight (LBW) have a high risk and will have an impact on subsequent development. Studies show that the use of hormonal contraceptives can increase the risk of experiencing subjective health complaints than non-hormonal contraceptives. The study is an analytical descriptive study that aims to identify the effect of hormonal contraceptive used on low birth weight baby delivery. The study was conducted in three agricultural hospitals and three public hospitals in the Agriculture area of Besuki Residency. Data analysis of the sample was carried out by quota sampling. Characteristics of respondents were displayed by univariate analysis. The total number of participants in this study were 441 participants. Participants were divided into several data categories such as age, parity, medical history, previous history of preeclampsia, low birth weight babies, contraceptives used, complications of premature rupture of membranes. There two factors, that can predict the low birth weight baby delivery. They are hormonal contraceptives use and premature rupture of membranes. The test results get the hormonal contraceptive used factor to be the strongest factor (OR 19,12). Thus it was concluded "the hormonal contraceptive used factor is an abdominal factor of low birth weight baby delivery with a significance value of 0.000 (p0.05).

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.

Comparison of Female Genital Tract Cytokine and Microbiota Signatures Induced by Initiation of Intramuscular DMPA and NET-EN Hormonal Contraceptives - a Prospective Cohort Analysis

BackgroundCervicovaginal inflammation, bacterial microbiota and hormonal contraceptives all influence sexual and reproductive health. To date, the effects of intramuscular depo-medroxyprogesterone acetate (DMPA-IM) versus injectable norethisterone enanthate (NET-EN) on vaginal microbiota or cytokines have not been compared back-to-back, although in-vitro data suggest that DMPA-IM and NET-EN have different pharmacokinetic and biologic activities. This study aimed at comparing the effects of DMPA-IM versus NET-EN initiation on cervicovaginal cytokines and microbiota in women at high risk for sexually transmitted infections (STIs) assigned to the respective contraceptives.MethodsWe collected socio-demographic characteristics and vaginal samples from women initiating DMPA-IM (ECHO Trial; n = 53) and NET-EN (UChoose Trial; n = 44) at baseline and after two consecutive injections to assess cytokine concentrations by Luminex, vaginal microbiota by 16S rRNA gene sequencing, STIs, bacterial vaginosis (BV) and candidiasis.ResultsCytokine concentrations did not change significantly after initiating DMPA-IM or NET-EN, although NET-EN versus DMPA-IM-associated profiles were distinct. While the abundance of bacterial taxa associated with optimal and non-optimal microbiota fluctuated with DMPA-IM use, overall community composition did not significantly change with either contraceptive. HSV-2 serology, chlamydial infection, gonorrhoea and candidiasis did not influence the associations between contraceptive type and cervicovaginal cytokines or microbiota.ConclusionsBoth DMPA-IM and NET-EN use did not lead to broad inflammatory or microbiota changes in the female genital tract of sub-Saharan African women. This suggests that NET-EN is likely a viable option for contraception in African women at high risk of BV and STIs.

Models and methods to characterise levonorgestrel release from intradermally administered contraceptives

Microneedle (MN)-based technologies have been proposed as a means to facilitate minimally invasive sustained delivery of long-acting hormonal contraceptives into the skin. Intradermal administration is a new route of delivery for these contraceptives and therefore no established laboratory methods or experimental models are available to predict dermal drug release and pharmacokinetics from candidate MN formulations. This study evaluates an in vitro release (IVR) medium and a medium supplemented with ex vivo human skin homogenate (SH) as potential laboratory models to investigate the dermal release characteristics of one such hormonal contraceptive that is being tested for MN delivery, levonorgestrel (LNG), and provides details of an accompanying novel two-step liquid–liquid drug extraction procedure and sensitive reversed-phase HPLC–UV assay. The extraction efficiency of LNG was 91.7 ± 3.06% from IVR medium and 84.6 ± 1.6% from the medium supplemented with SH. The HPLC–UV methodology had a limit of quantification of 0.005 µg/mL and linearity between 0.005 and 25 µg/mL. Extraction and detection methods for LNG were exemplified in both models using the well-characterised, commercially available sustained-release implant (Jadelle®). Sustained LNG release from the implant was detected in both media over 28 days. This study reports for the first time the use of biologically relevant release models and a rapid, reliable and sensitive methodology to determine release characteristics of LNG from intradermally administered long-acting drug delivery systems. Graphical abstract