Long Term Effects of Hormonal Contraceptives

1. Micah Crotts Master�s Presentation 03/27/08 Long Term Effects of Hormonal Contraceptives

2. Why do we care? Because it is prescribed a lot Popularity 100 Million Women Worldwide [3] Multiple Uses PMDD, Endometriosis, ect. Extended Duration of Use

3. Extended Duration of Use �The average age of mothers having their first child was 28.9 years for births registered in Quarter 1 2007, in 2000 the average American woman having her first baby was almost 25 years old[5].� � In 1970 the average age was 21.4 years for a first birth, according to a new report from the Centers for Disease Control and Prevention released today[4].�

4. Why the wait Education High School Diploma = College Degree Opt No! More accepted for women who are career focused (add up the years for these women)

5. Extended Duration Early menarche �Researchers noted the trend 140 years ago. In 1860 the average menarche happened at 16.6 years, in 1920 at 14.6, in 1950 at 13.1 and 1980, 12.5 years [7].�

6. Background In the 1920�s an American Zoologist named Samuel Leeson Leonard discovered that estrogen could be used to keep a female from becoming pregnant[3]. The scientists of the 1930�s to figure out that high doses of androgens, estrogens, or progesterone inhibit ovulation. Inventors Gregory Goodwin Pincus, John Rock, and Min Chueh Chang produced the first combined oral contraceptive which was approved for contraceptive use in the 1960�s for the United States[3].

7. MOA Whichever method used the basic principle involving the method of action is that an increase in estrogen and progesterone in the blood stream inhibits follicular development preventing the female body from ovulation therefore leaving no egg for which a sperm could fertilize.

8. First Spark of Worry �At the October 1995 CPMP meeting, committee members from the UK and Germany addressed the issue of combined oral contraceptives, especially gestodene- and desogestrel- containing oral contraceptive and deep vein thrombosis based on data from three independently conducted epidemiological studies� [6]. The CPMP position statement on April 17, 1996 was �Venous thromboemolism is a serious but rare risk associated with the use of oral contraceptives.�[6]

9. Solution Pharmaceutical companies researched and were able to produce other products that contain decreased amount of the active ingredients to try and minimize the potential side effects of combined oral contraceptives. Society seemed to be satisfied.

10. Study 1 �The start of HC was independently associated with worsening of BP, UAE and GFR, while stopping HC use resulted in an improvement. These data suggest that long-term HC use (aged 28-45 years) may be deleterious from the cardiovascular and renal point of view, but stopping may result in correction of these effects[1].� Worry about women with predispositions Which include all women since increased blood pressure predisposes a person to heart disease (#1 killer in America)

11. Study 2 �Regular and long-term oral contraceptive use and hormone replacement therapy are associated with an increased risk for microalbuminuria and cardiovascular disease [9].�

12. Study 3 �Endothelium-dependent arterial function measured by cardiovascular magnetic resonance is impaired in chronic users of DMPA, and hypoestrogenism may be the mechanism of action. DMPA might adversely affect cardiovascular heath and in particular its use in women with cardiovascular disease should be additionally evaluated [11].� So what do we really know?

13. What needs to be done More research, the need keeps increasing �Increased safety of oral contraceptives (OC) has resulted from a reduction in the estrogen and progestin content per tablet. A reduction in the number of hormonally active pills and their placement at critical points within the cycle may provide a novel regimen for further reducing the hormonal content of OC per cycle and their attendant side effects without compromising efficacy [8].�

14. Mirena �As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easy-to-use contraception after taking oral contraception[2].� PID which could cause infertility Cramping in the beginning Amenorrhea (bonus)

15. References Atthobari J, Gansevoort RT, Visser ST, de Jong PE, de Jong-van den Berg LT; PREVEND Study Group. �The impact of hormonal contraceptives on blood pressure, urinary albumin excretion and glomerular filtration rate.� Br J Clin Pharmacol. 2007 Feb;63(2):224-31. Collinet P, Nayama M, Cosson M. �Acceptability of intrauterine levonorgestrel delivery system (Mirena 52mg) after estrogen-progesterone oral contraception: results of a prospective multicentric study of 211 patients aged 25-35 years.� J Gynecol Obstet Biol Reprod (Paris). 2006 Dec;35(8 Pt 1):778-84. http://en.wikipedia.org/wiki/Combined_oral_contraceptive_pill http://www.cdc.gov/nchs/pressroom/02news/ameriwomen.htm http://www.cso.ie/newsevents/pressrelease_vitalstatisticsquarter12007.htm

16. References Cont. http://www.emea.europa.eu/pdfs/human/phv/007397en.pdf http://www.mum.org/menarage.htm Letterie GS. �A regimen of oral contraceptives restricted to the periovulatory period may permit folliculogenesis but inhibit ovulation.� Contraception. 1998 Jan;57(1):39-44. Monster TB, Janssen WM, de Jong PE, de Jong-van den Berg LT; Prevention of Renal and Vascular End Stage Disease Study Group. �Oral contraceptive use and hormone replacement therapy are associated with microalbuminuria.� Arch Intern Med. 2001 Sep 10;161(16):2000-5. Sorensen MB, Collins P, Ong PJ, Webb CM, Hayward CS, Asbury EA, Gatehouse PD, Elkington AG, Yang GZ, Kubba A, Pennell DJ. �Long-term use of contraceptive depot medroxyprogesterone acetate in young women impairs arterial endothelial function assessed by cardiovascular magnetic resonance.� Circulation. 2002 Sep 24;106(13):1646-51.