Hormone withdrawal symptoms in oral contraceptive users

doi:10.1016/S0029-7844(99)00524-4

Obstetrics & Gynecology

Volume 95, Issue 2, February 2000, Pages 261-266

https://doi.org/10.1016/S0029-7844(99)00524-4 Get rights and content

Abstract

Objective: To measure the timing, frequency, and severity of hormone-related symptoms in oral contraceptive (OC) users, specifically to compare active-pill with hormone-free intervals.

Methods: Using daily diaries, women recorded pelvic pain, bleeding, headaches, analgesic use, nausea or vomiting, bloating or swelling, and breast tenderness during active-pill intervals and hormone-free intervals. Participants either had no prior OC use, had taken OCs and were restarting, or had been taking OCs continuously for 12 months or longer.

Results: Two hundred sixty-two women, 26 with no previous OC use, 43 prior users, and 193 current users, provided daily records of hormone-related symptoms. Subjects with no prior OC use and prior users restarting were similar in no recent OC use, and because of the small sample, they were pooled for analysis as new-start OC users. Current users had patterns of symptoms that were more frequent during hormone-free intervals than during the three active-pill weeks. These included pelvic pain (70% versus 21%, P < .001), headaches (70% versus 53%, P < .001), use of pain medication (69% versus 43%, P < .001), bloating or swelling (58% versus 19%, P < .001), and breast tenderness (38% versus 16%, P < .001). Similar patterns were seen in new-start OC users after the first cycle. Among new-start OC users, menstrual flow patterns, headache, bloating or swelling, and breast-tenderness symptoms decreased during the three cycles to approach those levels of current users.

Conclusion: Almost all symptoms assessed were significantly worse during the 7-day hormone-free interval than during the 21 days of hormone-containing pills.

Section snippets

Materials and methods

Women who requested OCs were recruited from the obstetrics and gynecology practice of Scott and White Clinic from November 1996 to August 1997 and were eligible for participation if they had no prior OC use, had used OCs previously but not in the prior 3 months, or were current users of OCs for 12 months or more. Women not currently using OCs were considered new starts because they were never users or were not taking OCs for a minimum of 3 months before enrollment. All patients used a

Results

Among 334 women who signed consent forms, 262 (78%) returned detailed calendars for analysis. As displayed in Table 1, the women were similar in age, height, weight, BMI, race, and education. Subjects were predominately white (84%), and most had high school educations or greater (97%). Subjects with no prior use and current users had higher percentages of nulligravidas because prior users included many women who had delivered and were restarting OCs postpartum. As indicated in Table 1, women

Discussion

We documented that hormone-related symptoms sometimes varied between new starts and long-term users of OCs, and between active-pill and hormone-free weeks. In current OC users of more than 12 months, headaches were more common during hormone-free intervals compared with the active-pill weeks, probably because of the estrogen withdrawal effect on the vasculature from declining estrogen levels during hormone-free intervals. Menstrual migraines have occurred in spontaneous cycles in women not

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Women with attention-deficit/hyperactivity disorder (ADHD) have an increased risk of becoming teenage mothers. Adverse effects of hormonal contraception (HC), including depression, may affect adherence to user-dependent contraception and increase the risk for unplanned pregnancies and teenage births in women with ADHD. The current study analyzed whether girls and young women with ADHD are at increased risk for depression during HC use compared with women without ADHD.
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Women with ADHD had a 3-fold higher risk of developing depression, irrespective of HC use (adjusted hazard ratio [aHR] = 3.69, 95% CI = 3.60-3.78). Oral combined HC users with ADHD had a 5 times higher risk of depression compared with women without ADHD who were not using oral combined HC (aHR = 5.19, 95% CI = 4.94-5.47), and a 6 times higher risk in comparison with women without ADHD who were on oral combined HC (aHR = 6.10 (95% CI = 5.79-6.43). The corresponding risk of depression in women with ADHD who used a progestogen-only pill (aHR = 5.00, 95% CI = 4.56-5.49). The risk of developing depression when using non-oral HC was similarly moderately increased in both groups.
Girls and young women with ADHD have an increased risk of developing depression when using oral HC compared with their unaffected peers. Information on risks with HCs as well as potential benefits with long-acting reversible contraceptives needs to be an integrated part of the shared decision making and contraception counseling for young women with ADHD.
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La contraception estroprogestative (COP) demeure le moyen contraceptif le plus prescrit en France. De nouveaux schémas se développent (continu, étendu, flexible) pour espacer voire arrêter les saignements afin de répondre aux nouvelles attentes des femmes et améliorer leur qualité de vie. Cependant, aucune recommandation n’existe sur la façon de les prescrire. L’objectif de notre étude est de faire un état des lieux de la prescription des nouveaux schémas de prescription de contraception estroprogestative.
L’étude observationnelle descriptive s’est déroulée avec l’envoi d’un questionnaire à des gynécologues, médecins généralistes et sages-femmes exerçant ou se formant dans la région Centre Val de Loire. Leurs habitudes de prescriptions ainsi que leurs connaissances sur ces nouveaux schémas de prescription ont été évaluées.
Au total, 83 % des professionnels interrogés étaient prescripteurs de ces nouveaux schémas. Les principales indications étaient l’endométriose, les symptômes cataméniaux invalidants, le désir d’aménorrhée ainsi qu’une demande spontanée de la patiente. Le schéma « étendu » (pause du contraceptif existante mais non mensuelle) était celui le plus prescrit. Leurs connaissances sur les bénéfices de ces schémas étaient bonnes, contrairement à celles sur les recommandations des sociétés savantes.
Les nouveaux schémas de prescription de COP sont proposés par de nombreux professionnels de santé. Ceux-ci les prescrivent avec une grande variabilité. Des études visant à montrer les bénéfices en termes d’acceptabilité des différents schémas et associations de COP ainsi qu’un renforcement de l’information délivrée seraient nécessaires pour guider les professionnels dans leur pratique.
To date, oral contraceptives remain the most frequently prescribed contraceptive method. New combined oral contraceptive (COC) regimens (continued, extended or flexible) were developed to try and space out or avoid withdrawal bleedings in order to meet women's expectations and improve their quality of life. However, there is no recommendation published regarding the management of the prescription. The purpose of our study was to describe provider's prescription habits when it comes to new COC regimens.
This is a descriptive observational study. A questionnaire was sent to gynecologists, general practitioners and midwives employed or in training in the Centre Valde Loire region. Prescription habits and knowledge about new oral contraceptive regimens were evaluated.
83% of health professionals frequently prescribed new COC regimens. Most frequent indications were endometriosis, severe menstruation-associated symptoms, patient's desire for amenorrhea or patient's request. The extended regimen (hormone-free interval not every month) was the most frequently used. Provider's knowledge about indications and benefits of those new regimens were satisfactory. However, scientific societies guidelines were poorly acquired.
New COC regimens are frequently proposed by health care professionals with large variability in terms of prescription model. Along with reinforcement of COC prescription guidelines for healthcare professionals, further researches are needed to better understand differences in tolerability and acceptability in terms of quality of life of the several potential regimens.
Long-term safety of extended levonorgestrel-containing oral contraceptives in the United States
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To compare the safety profile of Seasonique, a 91-day levonorgestrel-containing combined oral contraceptive (COC_LNG), to 28-day COC_LNG regarding the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE).
A new user cohort study was conducted in a US health care database from 2006 to 2017. Each 91-day COC_LNG treatment episode in females was matched to up to four 28-day COC_LNG treatment episodes by propensity score. We identified VTE cases in either (1) an inpatient setting with ICD-9 and ICD-10 diagnosis codes of PE and/or DVT in the primary position, or (2) an outpatient setting with ICD-9 or ICD-10 diagnosis codes of DVT in conjunction with an anticoagulant medication dispensing or alteplase (thrombolytic) during the 30-day period following the date of DVT diagnosis. VTE was validated using medical records. We assessed the study endpoints in the two cohorts using incidence rates and Cox proportional hazards models adjusted for potential confounders.
Of the 25,593 treatment episodes in 91-day COC_LNG and 76,586 treatment episodes in 28-day COC_LNG, 35 and 68 patients had VTEs, respectively, corresponding to a hazard ratio (HR) of 1.40 (95% confidence interval [CI], 0.90–2.19). The VTE algorithm had a positive predictive value of 76.4% (95% CI, 66.2%–84.8%). ATEs were recorded in 13 and 28 episodes, respectively, with a corresponding HR of 1.21 (95% CI, 0.58–2.53).
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Citation Excerpt :
Oral contraception is well known to reduce pain during menstruation but these results confirm that dysmenorrhea frequently persists despite the intake of the pill. This has been shown in several studies: Sulak et al. previously show in a study in 262 women taking a standard oral contraception with a seven days hormone free interval that 70% of the women documented some degree of pelvic pain during the hormone free interval compared with a prevalence of 11-23% during active-pill weeks [15]. In a large European study of 5728 women, Nappi et al. [16] observed prevalence of dysmenorrhea in 46% of the women taking a combined oral contraception versus 55% (p < 0.0001) in non-users.
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This cross-sectional web-based survey was conducted from December 19^th2018 through January 10^th2019 among a representative sample of 3001 French women aged 16 to 50.
2375 women (79%) reported having pain during menstruation, currently or in the past. 52% reported being currently affected, 27% had been affected in the past and 21% never suffered. Among younger women under 24, 66% reported current dysmenorrhea. Mean rating of pain intensity, evaluated on a visual analog scale from 0 to 10, was 6 + 1.9 in women presently having dysmenorrhea and 42% reported rating between 7 and 10. The impact on daily life was strong and there was a significant reduction of SF-36 scores in women experiencing dysmenorrhea. Among the 79% of women affected by dysmenorrhea, (current or past) 53% never used any medication and respectively 58% and 66% never sought medical advice.
Dysmenorrhea is very frequent in France with a significant impact on daily life and Quality of Life. There is a real inadequacy in the recognition and the management of this pathology, too often considered as common by the patients. There is a strong need for better information of the women and to raise the awareness of first line health-care professionals that any dysmenorrhea and especially severe dysmenorrhea must be accurately assessed and managed with the available therapeutic means
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Most psychiatric disorders demonstrate sex differences in their prevalence and symptomatology, and in their response to treatment. These differences are particularly pronounced in mood disorders. Differences in sex hormone levels are among the most overt distinctions between males and females and are thus an intuitive underpinning for these clinical observations. In fact, treatment with estrogen and testosterone was shown to exert antidepressant effects, which underscores this link. Changes to monoaminergic signaling in general, and serotonergic transmission in particular, are understood as central components of depressive pathophysiology. Thus, modulation of the serotonin system may serve as a mechanism via which sex hormones exert their clinical effects in mental health disorders. Over the past 20 years, various experimental approaches have been applied to identify modes of influence of sex and sex hormones on the serotonin system. This chapter provides an overview of different molecular components of the serotonin system, followed by a review of studies performed in animals and in humans with the purpose of elucidating sex hormone effects. Particular emphasis will be placed on studies performed with positron emission tomography, a method that allows for human in vivo molecular imaging and, therefore, assessment of effects in a clinically representative context. The studies addressed in this chapter provide a wealth of information on the interaction between sex, sex hormones, and serotonin in the brain. In general, they offer evidence for the concept that the influence of sex hormones on various components of the serotonin system may serve as an underpinning for the clinical effects these hormones demonstrate.

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^☆: Supported by a grant from Scott, Sherwood, and Brindley Foundation, Temple, Texas.

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Original ArticlesHormone withdrawal symptoms in oral contraceptive users☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Contraception

Contraception

J Pain Symptom Manage

Pain

Contraception

Contraception

Contraception

Am J Obstet Gynecol

Obstet Gynecol

Original Articles
Hormone withdrawal symptoms in oral contraceptive users☆