Browsing by Subject "Oral contraceptives"

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    An Exploratory Analysis of Associations Between Eating Disordered Symptoms, Perceived Weight Changes and Oral Contraceptive Discontinuation Among Young Minority Women
    (Elsevier, 2013) Stidham Hall, Kelli; O’Connell White, Katharine; Rickert, Vaughn I.; Reame, Nancy K.; Westhoff, Carolyn L.; Pediatrics, School of Medicine
    Purpose: To explore associations between eating-disordered (ED) symptoms, perceived oral contraceptive (OC)-related weight changes, and OC discontinuation among young minority women. Methods: We conducted a prospective substudy of a randomized controlled trial evaluating the impact of a pill pack supply (3 vs. 7 months) on OC continuation among young urban women presenting to a university-affiliated community-based family planning clinic for OC management. Participants (n = 354) were adolescent (n = 173) and young adult (n = 181) women aged 13-24 years, predominantly underinsured and largely Hispanic (92%). We conducted a structured baseline interview that included an ED screening instrument. At the 6-month follow-up, we conducted a telephone interview to determine OC continuation and dimensions of perceived OC-related weight changes during the study period. Results: At baseline, 24% of the subjects fulfilled the moderate/severe ED symptom screen criteria (n = 60). By 6 months, 57% of the subjects (n = 200) reported weight changes and 62% (n = 218) had discontinued OC use. Unadjusted discontinuation rates were similar across age- and ED symptom groups. In multivariate analysis, both ED symptoms (odds ratio = .49, 95% confidence interval = .25-.96, p = .04) and perceived weight changes (odds ratio = .60, 95% confidence interval = .38-.94, p = .03) were negatively associated with OC continuation. Conclusions: ED symptoms and perceived weight changes were associated with an increased likelihood of OC discontinuation among these young women. Reproductive health practitioners should consider psychological symptoms when managing OC.
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    Cerebral Vein Thrombosis in Concomitant Combination Oral Contraceptive Pill Use and COVID-19​
    (2023-03) Owusu, Raiven; Bode, Leah; Jansen, Nicole; Libke, Megan; Mehta, Rakesh
    Case Description:  Patient is a 27-year-old female who presented with confusion, fever, and chills and was found to have a cerebral vein thrombosis (CVT) on MRI. She had a seven-year history of combination oral contraceptive pill (OCP) use and prior to onset of symptoms tested positive for COVID-19. After CVT diagnosis, she started apixaban, which was discontinued 6 months later. She decided to discontinue her OCP and had a copper intrauterine device (IUD) placed.  Clinical Significance:  CVT is a rare form of stroke that most commonly affects young women. Pregnancy, puerperium, and OCP all use induce a hypercoagulable state which increases risk for CVT. Estrogen causes increased circulating procoagulant factors in the plasma, and combined OCP users are often found to have an acquired resistance to activated protein C6, which both contribute to a hypercoagulable state. COVID-19-associated coagulopathy also induces concurrent hyper-inflammatory response, hypercoagulability, and vascular endothelial cell dysfunction. These pathologic mechanisms are believed to be linked to elevated plasma levels of coagulation factors and reduced fibrinolysis, resulting in prothrombotic events. COVID-19 infection is thought to exacerbate existing prothrombotic states like OCP use. Conclusion:  Concomitant hypercoagulable states, such as combination OCP use and COVID-19 coagulopathy, increase overall risk for thrombotic events. Patients with risk factors for hypercoagulability presenting with headache, visual changes, and confusion should be evaluated for CVT. Following a thrombotic event in a patient on combined OCPs, finding an alternative contraceptive that meets the patient’s reproductive goals and lowers their risk of repeat thromboembolic events is important. Progesterone-only and non-hormonal contraceptive options, such as IUDs, have a decreased risk of thrombosis compared to combined OCPs and can provide alternative contraceptive methods.