Iñaki Lete

Venous and pulmonary thromboembolism and combined hormonal contraceptives. Systematic review and meta-analysis

ABSTRACT Objective A systematic review of studies published between January 1995 and April 2010 aimed at determining the effect of combined hormonal contraceptives (CHCs), administered orally, transdermally or vaginally, on the risk of venous thromboembolism (VTE). Results Of the 625 potentially eligible references reviewed, 25 studies meeting the inclusion and exclusion criteria were entered in the meta-analysis. The pooled relative risks of VTE associated with the various CHCs, depending on their progestogen, were: gestodene vs. levonorgestrel 1.33 (95% confidence interval [CI]: 1.08–1.63); desogestrel vs. levonorgestrel 1.93 (95% CI: 1.31–2.83); and drospirenone vs. levonorgestrel 1.67 (95% CI: 1.10–2.55). The pooled adjusted odds ratio for norgestimate vs. levonorgestrel was 1.11 (95% CI: 0.84–1.46) and that for cyproterone acetate vs. levonorgestrel 1.65 (95% CI: 1.30–2.11). Conclusions The safest CHCs in terms of VTE are those containing levonorgestrel or norgestimate. The risk of VTE associated with desogestrel-, drospirenone- or cyproterone acetate-containing CHCs is greater than that associated with CHCs containing levonorgestrel. The increased risk of VTE found for CHCs with gestodene compared to CHCs with levonorgestrel seems smaller than in previous analyses. There were no differences in VTE risk between oral and transdermal CHCs containing norgestimate or norelgestromin, respectively.

Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997-2007.

BACKGROUND This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions. STUDY DESIGN Since 1997, representative samples of Spanish women of childbearing potential (15-49 years) have been surveyed by the Daphne Team every 2 years to gather data of contraceptive methods used. RESULTS During the study period, 1997 to 2007, the overall use of contraceptive methods increased from 49.1% to 79.9%. The most commonly used method was the condom (an increase from 21% to 38.8%), followed by the pill (an increase from 14.2% to 20.3%). Female sterilization and IUDs decreased slightly and were used by less than 5% of women in 2007. The elective abortion rate increased from 5.52 to 11.49 per 1000 women. CONCLUSIONS The factors responsible for the increased rate of elective abortion need further investigation.

Use of contraceptive methods in Spain: results of a national survey.

We conducted a personal interview of 2136 Spanish women aged 15 to 49 years with the aim of determining the contraceptive attitudes of this population. A stratified random sampling was performed to select the women who were to be interviewed, and this sampling design ensured adequate representation of the sample in Spain. At the time of the survey, only 1296 of the 2136 women used some type of contraceptive method (60.6%); the most commonly used method was the condom. The major reason given by the 840 women not using contraceptive methods was the absence of sexual intercourse. Nearly 25% of the Spanish women aged 15-49 years reported that they have no sexual relations.

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a representative cohort of Spanish women of fertile age

OBJECTIVE To assess the prevalence of premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder in a cohort of women of fertile age representative of the general Spanish population. STUDY DESIGN During the period between November 27th and December 22nd, 2008, a cross-sectional nationwide survey was conducted among a cohort of Spanish women aged between 15 and 49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. RESULTS Of the 2108 participants, 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. A total of 1415 (91%) women presented isolated symptoms and 139 (8.9%) a moderate/severe premenstrual syndrome. Twenty-four (1.1%) women fulfilled criteria for a diagnosis of premenstrual dysphoric disorder. CONCLUSION The prevalence of premenstrual symptoms (73.7%) and premenstrual dysphoric disorder (1.1%) in Spanish women aged between 15 and 49 years is similar to that reported in other Western countries. Only women with moderate or severe premenstrual syndrome or premenstrual dysphoric disorder, however, had daily life activities significantly impaired by premenstrual symptoms.

Spanish population at risk of unwanted pregnancy: results of a national survey

Objective: We performed a personal survey in 2218 Spanish women aged from 15 to 49 years to establish the contraceptive methods used by this population and to determine the number of Spanish women of childbearing age exposed to unwanted pregnancy. Methods: Stratified random sampling was performed to select the women to be interviewed; this sampling design ensured adequate representation of the sample in Spain. Results: At the time of the survey, 69.1% of the women were using some contraceptive method, but 5% of them used poorly effective contraceptive methods, and their exposure to the risk of an unwanted pregnancy was therefore high. Moreover, among the 30.9% not using any contraceptive method, 21.1% were at risk because they were having sexual intercourse, did not want to become pregnant and did not use a contraceptive method. Conclusions: A little over one million Spanish women are exposed to the risk of having an unwanted pregnancy. Compiling the data on this significant problem is the first step in designing appropriate solutions.

Position of the Spanish Menopause Society regarding the management of perimenopause

Perimenopause is an imprecise period in woman over 40 years of age, which comprises the time between the moment that the first changes in the menstrual cycle appear and the year following the definitive cessation of the menses. Besides irregular bleeding, many women also complain of hot flashes and other characteristic symptoms of postmenopause. Moreover, most of them are concerned about the future impact that these events may have on their health, such as needing health exams or continuing to use contraceptive methods. A panel of experts from the Spanish Menopause Society has met to establish diagnostic and therapeutic guidelines for this period based on the best available evidence.

Attitudes of Spanish women toward premenstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder: results of a nationwide survey

OBJECTIVE To assess the attitudes of women with premenstrual symptoms in relation to their perception of complaints and request for medical advice. STUDY DESIGN Cross-sectional study of a representative cohort of 2018 Spanish women aged 15-49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. RESULTS A total of 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. The prevalence of moderate or severe premenstrual syndrome (PMS) was 8.9% and the prevalence of premenstrual dysphoric disorder (PMDD) 1.1%. Only 291 (18.7%) women had sought medical advice. The main reason given by 90.6% of symptomatic women for not seeking medical consultation was to consider that symptoms were normal. A total of 175 (60.1%) women received pharmacological treatment (hormonal contraceptives in 95% followed by analgesics in 50% and anti-inflammatory agents in 44%), 20% were not treated because physicians considered that symptoms were not important and would disappear spontaneously, and 12% received only advice to change life style. CONCLUSION Women suffering from PMS or PMDD do not usually seek medical advice and among those seeking medical care, in many cases, an adequate response to their demands is not obtained.

Contraceptive practices of women requesting induced abortion in Spain: A cross-sectional multicentre study

ABSTRACT Objectives To collect information on (i) contraceptive methods used immediately before unwanted pregnancy, and (ii) planned contraception following induced abortion among Spanish residents. Methods Eight centres officially accredited to perform abortions participated in a cross-sectional study. The study population included 2475 women requesting induced abortion between 1 January and 31 March 2007. Results Contraceptive methods used before unwanted pregnancy were condoms in 40% of the cases, combined hormonal contraception in 14%, and other methods (mainly natural methods and withdrawal) in 10%. Thirty-six percent of women did not use any contraceptive method. Failure of the method due to incorrect use was reported by 77% of those using condoms and by 84% of those using hormonal contraception. Only 23% of women planned to use a contraceptive method after abortion. Almost half of the women were immigrants. Conclusion Despite the use of effective contraceptive methods, the majority of women requesting induced abortion in Spain became pregnant during the use of these methods. These data reflect a lack of compliance. More education programmes are needed to improve compliance rates. The long-acting reversible contraceptive methods could constitute an appropriate approach.

Use of contraceptive methods and risk of unwanted pregnancy in Spanish women aged 40-50 years: results of a survey conducted in Spain.

A survey intended to ascertain the rate of use and type of contraceptive methods applied by Spanish women aged 40 to 50 years, and to determine the proportion of women in this group at risk of an unwanted pregnancy, was designed and validated. To achieve representative national results for the study population, it was estimated that a sample size of 2000 women was required. Women were selected using probabilistic, stratified random sampling. The survey questionnaire was prepared by the research group with the collaboration of experts in the conduct of population studies of this type. Participants were interviewed face to face by qualified and trained staff from a specialised company external to the research group. Overall, 1039 women (52%) resorted to some contraceptive method, of which (male or female) sterilisation was the most common. We estimate that in Spain there are 840,000 women (31.8%) aged 40 to 50 years at risk of unwanted pregnancy.

Vaginal health in contraceptive vaginal ring users – A review

Abstract Background To provide an overview of the available data from clinical studies of vaginal conditions in women who use a vaginal ring as a contraceptive. Methods A systematic review of the literature. Results Millions of women have already used the ethylene vinyl acetate vaginal ring that releases ethinylestradiol and etonogestrel for contraception. Because of its small size, more than four out of five women using the ring report that they do not feel it, even during sexual intercourse. No colposcopic or cytological changes have been observed in users, although approximately 10% have increased vaginal discharge. While in vitro studies have shown adhesion of Candida yeasts to the vaginal ring surface, clinical studies have not demonstrated a greater incidence of Candida infections compared to users of equivalent oral contraceptives. Some clinical studies suggest a lower incidence of bacterial vaginosis. No interaction exists between concomitant use of the vaginal ring and other drugs or products for vaginal use. Conclusion The use of a contraceptive vaginal ring does not alter the vaginal ecosystem and therefore does not substantially affect vaginal health.