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Concept: Implanon

185

In recent years there has been an explosion in the development of medical apps, with more than 40,000 apps now available. Nearly 100 apps allow women to track their fertility and menstrual cycles and can be used to avoid or achieve pregnancy. Apps offer a convenient way to track fertility biomarkers. However, only some use evidence-based fertility awareness-based methods (FABMs), which with ideal use have rates of effectiveness similar to those of commonly used forms of hormonal birth control. Since having a baby or preventing a pregnancy are important responsibilities, it is critical that women and couples have access to reliable, evidence-based apps that allow them to accurately track their fertility.

Concepts: Pregnancy, Birth control, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Progesterone, Implanon, Fertility awareness

33

Previous studies have shown changes in women’s behavior and physical appearance between the non-fertile and fertile phases of the menstrual cycle. It is assumed that these changes are regulated by fluctuations in sex hormone levels across the cycle. Receptors for sex hormones have been found on the vocal folds, suggesting a link between hormone levels and vocal fold function, which might cause changes in voice production. However, attempts to identify changes in voice production across the menstrual cycle have produced mixed results. Therefore, the purpose of this study was to investigate changes in sexually dimorphic vocal characteristics and quality of women’s voices in different phases of the cycle and to compare these with users of monophasic hormonal contraception. Voice samples (vowel phonation) of 44 naturally cycling women were obtained in the menstrual, late follicular (confirmed by LH surge) and luteal phases, and in 20 hormonal contraceptive users across equivalent stages of the monthly cycle. Results showed that voices of naturally cycling women had higher minimum pitch in the late follicular phase compared with the other phases. In addition, voice intensity was at its lowest in the luteal phase. In contrast, there were no voice changes across the cycle in hormonal contraceptive users. Comparison between the two groups of women revealed that the naturally cycling group had higher minimum pitch in the fertile phase and higher harmonics to noise ratio in the menstrual phase. In general, present results support the assumption that sex hormones might have an effect on voice function. These results, coupled with mixed findings in previous studies, suggest that vocal changes in relation to hormonal fluctuation are subtle, at least during vowel production. Future studies should explore voice changes in a defined social context and with more free-flowing speech.

Concepts: Birth control, Emergency contraception, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Human voice, Ovulation, Implanon

24

Although hormonal contraceptives may help acne or worsen it, there is limited evidence on the effects of many commonly prescribed agents. The present study evaluates patient-reported effect on acne from 2147 patients who were utilizing a hormonal contraceptive at the time of their initial consultation for acne.
METHODS: At the time of initial consultation for acne, each of 2147 consecutive patients using hormonal contraception provided her assessment of how her contraceptive had affected her acne. The Kruskal-Wallis test and logistic regression analysis were used to compare patient-reported outcomes by contraceptive type.
RESULTS: Depot injections, subdermal implants, and hormonal intrauterine devices worsened acne on average, and were inferior to the vaginal ring and combined oral contraceptives (COCs; P ≤ .001 for all pairwise comparisons), which improved acne on average. Within COC categories, a hierarchy emerged based on the progestin component, where drospirenone (most helpful) > norgestimate and desogestrel > levonorgestrel and norethindrone (P ≤ .035 for all pairwise comparisons). The presence of triphasic progestin dosage in COCs had a positive effect (P = .005), while variation in estrogen dose did not have a significant effect (P = .880).
CONCLUSIONS: Different hormonal contraceptives have significantly varied effects on acne, including among types of COC.

J Drugs Dermatol. 2016;15(6):670-674.

Concepts: Birth control, Emergency contraception, Hormonal contraception, Combined oral contraceptive pill, Progestin, Menstrual cycle, Implanon, Ormeloxifene

15

We performed a systematic review to look for an association between progestin-only contraception and depression.

Concepts: Birth control, Hormonal contraception, Combined oral contraceptive pill, Progestin, Implanon

13

Context: Combinations of testosterone (T) and nestorone (NES; a nonandrogenic progestin) transdermal gels may suppress spermatogenesis and prove appealing to men for contraception. Objective: The objective of the study was to determine the effectiveness of T gel alone or combined with NES gel in suppressing spermatogenesis. Design and Setting: This was a randomized, double-blind, comparator clinical trial conducted at two academic medical centers. Participants: Ninety-nine healthy male volunteers participated in the study. Interventions: Volunteers were randomized to one of three treatment groups applying daily transdermal gels (group 1: T gel 10 g + NES 0 mg/placebo gel; group 2: T gel 10 g + NES gel 8 mg; group 3: T gel 10 g + NES gel 12 mg). Main Outcome Variable: The main outcome variable of the study was the percentage of men whose sperm concentration was suppressed to 1 million/ml or less by 20-24 wk of treatment. Results: Efficacy data analyses were performed on 56 subjects who adhered to the protocol and completed at least 20 wk of treatment. The percentage of men whose sperm concentration was 1 million/ml or less was significantly higher for T + NES 8 mg (89%, P < 0.0001) and T + NES 12 mg (88%, P = 0.0002) compared with T + NES 0 mg group (23%). The median serum total and free T concentrations in all groups were maintained within the adult male range throughout the treatment period. Adverse effects were minimal in all groups. Conclusion: A combination of daily NES + T gels suppressed sperm concentration to 1 million/ml or less in 88.5% of men, with minimal adverse effects, and may be further studied as a male transdermal hormonal contraceptive.

Concepts: Birth control, Emergency contraception, Hormonal contraception, Combined oral contraceptive pill, Effectiveness, Menstrual cycle, Spermatogenesis, Implanon

12

Access to effective affordable contraception for women is critical for individual and public health. A wide range of hormonal contraceptives (HCs) which differ in the composition, concentration of progestin component, frequency of dosage and method of administration, is currently available globally. However, the options are rather limited in settings with restricted economic resources that frequently overlap with areas of high HIV-1 prevalence. The predominant contraceptive used in Sub-Saharan Africa is the progestin-only three-monthly injectable depo-medroxyprogesterone acetate (DMPA). Determination of whether HCs affect HIV-1 acquisition has been hampered by behavioral differences potentially confounding clinical observational data. Meta-analysis of these studies shows a significant association between DMPA use and increased risk of HIV-1 acquisition, raising important concerns. No association was found for combined oral contraceptives (COCs) containing levonorgestrel, nor for the two-monthly injectable contraceptive norethisterone enanthate (NET-EN), although data for NET-EN are limited. Susceptibility to HIV-1 and other sexually transmitted infections (STIs) may, however, be dependent on the type of progestin present in the formulation. Several underlying biological mechanisms that may mediate the effect of HCs on HIV-1 and other STI acquisition have been identified in clinical, animal, and ex vivo studies. A significant gap exists in the translation of basic research into clinical practice and public health policy. To bridge this gap, we review the current knowledge of underlying mechanisms and biological effects of commonly used progestins. The review sheds light on issues critical for an informed choice of progestins for the identification of safe, effective, acceptable and affordable contraceptive methods.

Concepts: Birth control, Emergency contraception, Epidemiology, Hormonal contraception, Combined oral contraceptive pill, Progestin, Sexually transmitted disease, Implanon

12

Long-acting reversible contraception (LARC) is effective and acceptable. However, concern exists about potential provider bias in LARC promotion. No study has documented contraceptive users' attitudes toward or experiences with provider influence and bias regarding LARC. We collected qualitative data in 2014 to address this gap. Participants were 50 young adult women with any history of contraceptive use (including LARC) in Dane County, Wisconsin. Women often described providers as a trusted source of contraceptive information. However, several women reported that their preferences regarding contraceptive selection or removal were not honored. Furthermore, many participants believed that providers recommend LARC disproportionately to socially marginalized women. We encourage contraceptive counseling and removal protocols that directly address historical reproductive injustices and that honor patients' wishes. (Am J Public Health. Published online ahead of print September 15, 2016: e1-e6. doi:10.2105/AJPH.2016.303393).

Concepts: Birth control, Family planning, Implanon, Qualitative data, Adult, Young adult, Dane County, Wisconsin

10

Hormonal variation over the menstrual cycle alters women’s preferences for phenotypic indicators of men’s genetic or parental quality. Hormonal contraceptives suppress these shifts, inducing different mate preference patterns among users and non-users. This raises the possibility that women using oral contraception (OC) choose different partners than they would do otherwise but, to date, we know neither whether these laboratory-measured effects are sufficient to exert real-world consequences, nor what these consequences would be. Here, we test for differences in relationship quality and survival between women who were using or not using OC when they chose the partner who fathered their first child. Women who used OC scored lower on measures of sexual satisfaction and partner attraction, experienced increasing sexual dissatisfaction during the relationship, and were more likely to be the one to initiate an eventual separation if it occurred. However, the same women were more satisfied with their partner’s paternal provision, and thus had longer relationships and were less likely to separate. These effects are congruent with evolutionary predictions based on cyclical preference shifts. Our results demonstrate that widespread use of hormonal contraception may contribute to relationship outcome, with implications for human reproductive behaviour, family cohesion and quality of life.

Concepts: Birth control, Emergency contraception, Sexual intercourse, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Implanon, Norplant

8

Hormonal fluctuation across the menstrual cycle explains temporal variation in women’s judgment of the attractiveness of members of the opposite sex. Use of hormonal contraceptives could therefore influence both initial partner choice and, if contraceptive use subsequently changes, intrapair dynamics. Associations between hormonal contraceptive use and relationship satisfaction may thus be best understood by considering whether current use is congruent with use when relationships formed, rather than by considering current use alone. In the study reported here, we tested this congruency hypothesis in a survey of 365 couples. Controlling for potential confounds (including relationship duration, age, parenthood, and income), we found that congruency in current and previous hormonal contraceptive use, but not current use alone, predicted women’s sexual satisfaction with their partners. Congruency was not associated with women’s nonsexual satisfaction or with the satisfaction of their male partners. Our results provide empirical support for the congruency hypothesis and suggest that women’s sexual satisfaction is influenced by changes in partner preference associated with change in hormonal contraceptive use.

Concepts: Birth control, Emergency contraception, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Implanon, Fertility awareness, Norplant

4

Measures of contraceptive effectiveness combine technology and user-related factors. Observational studies show higher effectiveness of long-acting reversible contraception (LARC) compared to short-acting reversible contraception (SARC). Women who choose LARC may differ in key ways from women who choose SARC, and it may be these differences that are responsible for the high effectiveness of LARC. Wider use of LARC is recommended, but scientific evidence of acceptability and successful use is lacking in a population that typically opts for short-acting methods.

Concepts: Scientific method, Pregnancy, Birth control, Sexual intercourse, Menstrual cycle, Abortion, Implanon, Birth rate