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Cognitive consequences of hormonal contraceptives (HCs) are largely underexplored, despite the popularity of use. This study investigates the association between perseverance during cognitively challenging tasks and the use of HCs among Danish women. We hypothesised that women using HCs show decreased perseverance across tasks compared to their naturally cycling counterparts. We further hypothesised that HC using women would show decreased performance as a measure of accuracy (i.e. more incorrect answers) compared to naturally cycling women. The study used a cross-sectional repeated measures design, consisting of a Danish version of the Anagram Persistence Task and the Hagen Matrices Test, followed by an extensive survey documenting menstrual and HC history for each participant. The study was conducted online. Data processing was conducted on data from 129 participants. The former hypothesis was analysed through multilevel regression with a nested random effects structure on log-transformed data. The latter hypothesis was analysed through a multilevel generalised linear model with a nested random effects structure using the binomial family. No support was found for either of the hypotheses.
In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.
To assess the association of the use of HC with the risk of AS during 2017-2019.
Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.
Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).
A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing HC.
How attractive we find ourselves decides who we target as potential partners and influences our reproductive fitness. Self-perceptions on women's fertile days could be particularly important. However, results on how self-perceived attractiveness changes across women's ovulatory cycles are inconsistent and research has seldomly assessed multiple attractiveness-related constructs simultaneously. Here, we give an overview of ovulatory cycle shifts in self-perceived attractiveness, sexual desirability, grooming, self-esteem and positive mood. We addressed previous methodological shortcomings by conducting a large, preregistered online diary study of 872 women (580 naturally cycling) across 70 consecutive days, applying several robustness analyses and comparing naturally cycling women with women using hormonal contraceptives. As expected, we found robust evidence for ovulatory increases in self-perceived attractiveness and sexual desirability in naturally cycling women. Unexpectedly, we found moderately robust evidence for smaller ovulatory increases in self-esteem and positive mood. Although grooming showed an ovulatory increase descriptively, the effect was small, failed to reach our strict significance level of .01 and was not robust to model variations. We discuss how these results could follow an ovulatory increase in sexual motivation while calling for more theoretical and causally informative research to uncover the nature of ovulatory cycle shifts in the future.
Evidence associating serum 25-hydroxyvitamin D (25(OH)D) concentrations and cardiometabolic risk factors is inconsistent and studies have largely been conducted in adult populations. We examined the prospective associations between serum 25(OH)D concentrations and cardiometabolic risk factors from adolescence to young adulthood in the West Australian Pregnancy Cohort (Raine) Study. Serum 25(OH)D concentrations, BMI, homoeostasis model assessment for insulin resistance (HOMA-IR), TAG, HDL-cholesterol and systolic blood pressure (SBP) were measured at the 17-year (n 1015) and 20-year (n 1117) follow-ups. Hierarchical linear mixed models with maximum likelihood estimation were used to investigate associations between serum 25(OH)D concentrations and cardiometabolic risk factors, accounting for potential confounders. In males and females, respectively, mean serum 25(OH)D concentrations were 73·6 (sd 28·2) and 75·4 (sd 25·9) nmol/l at 17 years and 70·0 (sd 24·2) and 74·3 (sd 26·2) nmol/l at 20 years. Deseasonalised serum 25(OH)D3 concentrations were inversely associated with BMI (coefficient −0·01; 95 % CI −0·03, −0·003; P=0·014). No change over time was detected in the association for males; for females, the inverse association was stronger at 20 years compared with 17 years. Serum 25(OH)D concentrations were inversely associated with log-HOMA-IR (coefficient −0·002; 95 % CI −0·003, −0·001; P<0·001) and positively associated with log-TAG in females (coefficient 0·002; 95 % CI 0·0008, 0·004; P=0·003). These associations did not vary over time. There were no significant associations between serum 25(OH)D concentrations and HDL-cholesterol or SBP. Clinical trials in those with insufficient vitamin D status may be warranted to determine any beneficial effect of vitamin D supplementation on insulin resistance, while monitoring for any deleterious effect on TAG.
This chapter focuses on the non-oral combined hormonal contraceptive options, including the patch and more specifically the vaginal ring, which are underused in the UK and Australia. The clinical effectiveness unit of the faculty of sexual and reproductive healthcare developed a guideline to facilitate appropriate investigation of women presenting with unscheduled bleeding. For women with breakthrough bleeding in association with the use of hormonal contraception, lasting longer than three months, it is important to view the cervix. A pelvic examination should be undertaken to exclude pelvic pathology including ovarian cysts, fibroids and gynaecological cancers. In clinical trials, most users have been satisfied with the combined hormonal ring. The greatest barrier to this method is promoting the vagina as an ideal organ in which to place hormonal contraception and this remains a challenge to all providers of contraception.
Synthetic derivatives of progesterone are variously known as progestogens, progestagens or progestins and have a key role in hormonal contraception, either alone or in combination with oestrogen. Progestogen-only methods of contraception include pills, subdermal implants, injectables and the intrauterine system. There are several different types of subdermal implant licensed for contraceptive use across the world. The Nexplanon implant contains etonogestrel and is the most widely available subdermal contraceptive implant. Other progestogen-only contraceptive implants are licensed or being developed and include Jadelle, a two-rod implant containing levonorgestrel, and Capronor, a biodegradable single-rod implant also containing levonorgestrel. The two types of progestogen-only injectable contraception, both of which are long-acting reversible contraception (LARC) methods, are depot-medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NETEN). The most commonly used progestogen-releasing intrauterine system in most countries is the levonorgestrel-releasing intrauterine system (LNG-IUS) known as Mirena.
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