Waleska Modesto

Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use

Abstract Background and objective Data on record regarding weight variation in depot-medroxyprogesterone acetate (DMPA) and levonorgestrel-releasing intrauterine system (LNG-IUS) users are controversial. To date, no studies have yet evaluated weight variation in DMPA and LNG-IUS users in up to ten years of use compared to non-hormonal contraceptive users. Materials and methods A retrospective study analysed weight variations in 2138 women using uninterruptedly DMPA (150 mg intramuscularly, three-monthly; n = 714), the LNG-IUS (n = 701) or a copper-intrauterine device (Cu-IUD; n = 723). Results At the end of the first year of use, there was a mean weight increase of 1.3 kg, 0.7 kg and 0.2 kg among the DMPA-, LNG-IUS- and Cu-IUD users, respectively, compared to weight at baseline (p < 0.0001). After ten years of use, the mean weight had risen by 6.6 kg, 4.0 and 4.9 kg among the DMPA-, LNG-IUS- and Cu-IUD users, respectively. DMPA-users had gained more weight than LNG-IUS- (p = 0.0197) and than Cu-IUD users (p = 0.0294), with the latter two groups not differing significantly from each other in this respect (p = 0.5532). Conclusion Users of hormonal and non-hormonal contraceptive methods gained a significant amount of weight over the years. DMPA users gained more weight over the treatment period of up to ten years than women fitted with either a LNG-IUS or a Cu-IUD. Chinese Abstract 摘要 背景和目的 目前大多关于使用醋酸甲羟孕酮、左炔诺孕酮——宫内释放系统以及含铜宫内节育器避孕的妇女体重改变的资料数据是有争议的。到目前为止，还没有关于使用醋酸甲羟孕酮、左炔诺孕酮——宫内释放系统避孕与非激素避孕方法十年妇女体重变化的研究。 材料和方法 回顾性地研究了2138名妇女，包括持续使用醋酸甲羟孕酮（每3个月肌肉注射150mg； n= 714），使用左炔诺孕酮—宫内释放系统(n= 701)或者使用含铜宫内节育器避孕(Cu-IUD; n= 723). 结果 在所有的研究对象中，在使用的第一年末，相比较于她们的基础体重，使用醋酸甲羟孕酮、左炔诺孕酮—宫内释放系统以及含铜宫内节育器避孕的妇女分别有1.3 kg, 0.7 kg 和0.2 kg体重的增加(p ＜0.0001)。在使用十年以后，使用醋酸甲羟孕酮、左炔诺孕酮—宫内释放系统以及含铜宫内节育器避孕的妇女分别有6.6 kg, 4.0 和 4.9 kg体重的增加。与使用左炔诺孕酮—宫内释放系统和含铜宫内节育器避孕的妇女相比，使用醋酸甲羟孕酮避孕的妇女体重增加更多，p值分别为 0.0197和0.0294；而使用前二者避孕方法的妇女体重的改变相互没有显著性差异 (p= 0.5532). 结论 长期使用不论是激素避孕还是非激素避孕方法的妇女体重都有显著增加。使用醋酸甲羟孕酮避孕十年的妇女比使用左炔诺孕酮—宫内释放系统以及含铜宫内节育器避孕的妇女的体重增加更多。

Assessment of the quality of cervical mucus among users of the levonorgestrel-releasing intrauterine system at different times of use

Abstract Background and objectives: The quality of cervical mucus (CM) among the levonorgestrel-releasing intrauterine system (LNG-IUS) users is controversial. The objectives were to assess CM compared to the levels of oestradiol (E2) and the frequency of cycles with luteal activity among users of the LNG-IUS. Materials and methods: In total, 224 LNG-IUS users for between two months and five years were recruited at a Brazilian family planning clinic. For the cross-sectional part of the study, we enrolled 175 LNG-IUS users at 2, 6 12, 24, 36, 48, and 60 months after insertion (25 women in each group), and we performed one evaluation. For the prospective part of the study, we enrolled 49 LNG-IUS users at the same lengths of use after insertion (7 women in each group), and we evaluated these women once a week for five consecutive weeks. . Results: Mean (± SEM) CM scores of all evaluations among women with single and weekly evaluations were between 3.3 ± 0.9 and 8.5 ± 0.3, respectively independently of the length of use of the LNG-IUS. Mean E2 values ranged from 45.5 ± 6.8 to 472.5 ± 34.7 pg/ml and the maximum ovarian follicle diameter on the days of evaluation varied from 14.0 ± 1.3 to 31.2 ± 0.4 mm. Conclusions: The mean CM score of all evaluations, independent of the length of use of the LNG-IUS and normal levels of serum E2, was below 10 was according to the WHO is inadequate for sperm penetration.

Body composition and weight gain in new users of the three-monthly injectable contraceptive, depot-medroxyprogesterone acetate, after 12 months of follow-up

Abstract Objectives To evaluate weight gain and body composition (BC) in new users of depot-medroxyprogesterone acetate (DMPA) as a contraceptive. Methods This cohort study followed up 20 DMPA users and 20 copper intrauterine device (TCu380A IUD) users, paired for age (± 1 year) and body mass index (BMI ± 1 kg/m2), during 12-months. Healthy, non-obese women aged 18 to 40 years, unaffected by conditions that could influence their body weight, were enrolled. Socio-demographic variables, habits, weight, BMI, BC using dual-energy X-ray absorptiometry, circumferences, skinfold thickness, body fat percentage and waist-to-hip ratio were evaluated. All participants were encouraged to adopt healthy habits. Results At baseline, median age was 29 and 30.5 years, and mean BMI was 24.8 and 24.5 kg/m2 in the DMPA and IUD groups, respectively. At 12 months, an increase was observed in waist and hip circumference in the DMPA users and 8/20 of them had a weight gain ≥ 5% (mean 4.6 kg) with accumulation of fat centrally. Conclusions There were no differences in weight gain or in BC measurements between the groups; nevertheless 40% of women in the DMPA group had larger weight gain and accumulation of fat centrally. The duration of follow-up may have been insufficient to detect differences between the groups. Chinese Abstract 摘要 目的 研究应用长效甲羟孕酮避孕对体重和身体成分的影响 方法 分别选取20名妇女开始使用长效甲羟孕酮避孕（DMPA组）以及20名开始使用含铜宫内节育器避孕（IUD组）进行队列研究，并按照年龄( ±1 岁)、体重指数（BMI± 1 kg/m2 ）进行配对。40名18-40岁的健康、体重适宜、没有其他可能影响体重因素的妇女入选。记录研究对象的社会人口学特征、生活习惯、体重、体重指数、应用X线骨密度仪测量身体成分、手臂、腰、臀以及大腿的周径、皮肤褶皱的厚度、体脂的百分比以及腰臀比的数据。鼓励所有的研究对象选取健康的生活方式及饮食习惯。 结果 入选时两组妇女的平均年龄分别为29岁及30.5岁，体重指数分别为24.8kg/m2以及24.5 kg/m2。12个月后DMPA组的妇女有腰围和臀围的增加，8/20的妇女体重增加≥5%（平均4.6kg）伴有中央性脂肪蓄积的特点。 结论 使用DMPA以及使用含铜IUD12个月后的两组妇女在体重增加以及身体成分上的变化没有差异，但是DMPA组有40%的妇女有更多的体重增加以及体脂的中央性蓄积。研究可能需要更长的随访时间来发现两组的差异。

Exploratory study of the effect of lifestyle counselling on bone mineral density and body composition in users of the contraceptive depot-medroxyprogesterone acetate

Abstract Objectives To compare variations in bone mineral density (BMD) and body composition (BC) in depot-medroxyprogesterone acetate (DMPA) users and nonusers after providing counselling on healthy lifestyle habits. Methods An exploratory study in which women aged 18 to 40 years participated: 29 new DMPA users and 25 new non-hormonal contraceptive users. All participants were advised on healthy lifestyle habits: sun exposure, walking and calcium intake. BMD and BC were assessed at baseline and 12 months later. Statistical analysis included the Mann-Whitney test or Students t-test followed by multiple linear regression analysis. Results Compared to the controls, DMPA users had lower BMD at vertebrae L1 and L4 after 12 months of use. They also had a mean increase of 2 kg in total fat mass and an increase of 2.2% in body fat compared to the non-hormonal contraceptive users. BMD loss at L1 was less pronounced in DMPA users with a calcium intake ≥ 1 g/day compared to DMPA users with a lower calcium intake. Conclusions DMPA use was apparently associated with lower BMD and an increase in fat mass at 12 months of use. Calcium intake ≥ 1 g/day attenuates BMD loss in DMPA users. Counselling on healthy lifestyle habits failed to achieve its aims. Chinese Abstract 摘 要 目的 比较健康生活习惯指导对长效醋酸甲羟孕酮应用者和不用者骨密度和体成分影响的差异。 方法 一项针对年龄在18岁至40岁妇女的探索性研究：29名用长效醋酸甲羟孕酮，25名用非激素类避孕。建议所有的参与者都养成健康的生活习惯：晒太阳，散步和摄入钙。在开始和12个月后评估骨密度和体成分。统计分析包括Mann-Whitney检验或多元线性回归分析后行t-检验。 结果 与对照组相比，用长效醋酸甲羟孕酮12个月后，脊椎L1和L4的骨密度较低。与非激素避孕药使用者比，他们的平均总脂肪增加了2kg，并且体内的脂肪增加2.2%；每天摄入1g钙的长效醋酸甲羟孕酮组与较低钙摄入的长效醋酸甲羟孕酮组比，两组L1的骨密度丢失不太明显。 结论 醋酸甲羟孕酮的使用与骨密度降低明显相关，并且用药12个月后脂肪含量增加。使用醋酸甲羟孕酮时，每天摄入1克钙会抑制骨质丢失。健康生活习惯的建议未能实现其目标。

Relationship between user satisfaction with the levonorgestrel‐releasing intrauterine system and bleeding patterns

Satisfaction with a contraceptive method constitutes an important factor in its acceptance and long‐term use. The objective of this study was to assess the relationship between user satisfaction with the 20‐μg/day levonorgestrel‐releasing intrauterine system (LNG‐IUS) and the bleeding patterns reported at two different time‐points during follow‐up.

Body composition in long-term users of depot medroxyprogesterone acetate

Objective The aim of this study was to assess body composition (BC) among depot medroxyprogesterone acetate (DMPA) users and compare this with copper-intrauterine (Cu-IUD) users with up to 15 years of uninterrupted use. Study design This was a cross-sectional study. Patients and methods We evaluated BC in women (18–40 years of age) using dual X-ray absorptiometry. Results At the end of the first 37 years of use, the mean weight was 64.4±8.5 kg in DMPA users, a nonsignificantly higher mean compared with 59.9±6.4 kg among the Cu-IUD users (P=0.069). The mean of fat mass were 39.0±7.1 and 38.7±4.8% (P=0.898) and the lean mass were 35.8±2.7 and 33.2±2.8 kg (P=0.005) in DMPA/Cu-IUD users, respectively. Conclusion At long-term use of both methods, the BC did not show significant differences. Furthermore, DMPA users did not show significant differences in weight gain or increased lean and fat mass compared with Cu-IUD users.

Gasto energético e medidas antropométricas de novas usuárias do contraceptivo injetável trimestral de acetato de medroxiprogesterona de depósito

Objective:The objective of this study was to assess energy expenditure and the anthropometric profile of women during the first year of use of depot medroxyprogesterone acetate contraception.Methods:This prospective study included healthy non-obese women who had never used depot-medroxyprogesterone acetate and did not have a history of weight fluctuations. The women were divided into two groups composed of 28 depot medroxyprogesterone acetate users and 24 copper intrauterine device (TCu380A) users. They were paired for age (+1 year) and body mass index (+1 kg/m2). The following variables were used: sociodemographic characteristics (age, ethnicity, smoking status, alcohol consumption, physical activity, economic class, and education level), weight (kg), body max index, resting and total energy expenditure, waist and hip circumferences (cm), and waist-to-hip ratio.Results:The age of the women studied ranged from 20-39 years. The mean values of age/body mass index ratio were 29.6 (SD=+5.2) years/23.9 (+3.6 kg/m2) in the depot medroxyprogesterone acetate group and 28.6 (SD=+5.2) years/24.5 (+2.7 kg/m2) in the intrauterine device group. After conducting repeated measures analysis of variance, the users of depot medroxyprogesterone acetate showed weight gain of 2.2 kg, and those in the intrauterine device group showed weight loss of 0.2 kg without statistically significant difference between the groups. There were no significant differences between the other variables.Conclusion:There were no changes in weight, anthropometric measurements, and energy expenditure in the young and healthy women during the first year of use of depot medroxyprogesterone acetate contraception. Guidelines and recommendations for a healthy lifestyle to avoid changes in the anthropometric measurements are important for weight control in users of contraceptive methods.

A Randomized Clinical Trial of the Effect of Intensive Versus Non-intensive Counseling on Discontinuation Rates Due to Bleeding Disturbances of Three Long-Acting Reversible Contraceptives

Long-acting reversible contraceptives (LARCs) include the etonogestrel (ENG)–releasing subdermal implant, the levonorgestrel-releasing intrauterine system (LNG-IUS), and the TCu380A intrauterine device (IUD). Despite the high contraceptive efficacy of LARCs, adverse effects may lead to their premature removal, reduce continuation rates, and potentially increase unintended pregnancies. The primary reason for premature discontinuation is unpredictable menstrual bleeding, especially for users of the ENG-implant and the LNG-IUS. Counseling is a well-accepted strategy to improve acceptance, continuation, and satisfaction among contraceptive users and new users. The aim of this randomized clinical trial was to determine whether intensive counseling before insertion and during the first year of use would reduce discontinuation rates due to unpredictable menstrual bleeding in new users of these 3 LARCs. The study was conducted between 2011 and 2013 at an obstetrics-gynecology clinic in Brazil. Contraceptive efficacy and satisfaction rates were investigated for 98 users of the ENG-releasing implant, 99 users of the LNG-IUS, and 100 users of the TCu380A IUD. Each participant had been allowed to choose any one of these methods. Subjects were randomized to 1 of uthorized reproduction of this article is prohibited. 25 Office Gynecology 2 counseling strategies: Women in group I received routine counseling at the clinic, which included information on safety, efficacy, and adverse effects, especially the likelihood of bleeding. Women in group II received the same information, but in addition were given “intensive counseling,” which included leaflets on their chosen method and counseling throughout 1 year of follow-up by the same 3 professionals, who were the most experienced at the clinic. All subjects were instructed to return to the clinic after 45 (+7) days and at 6 and 12 (+1) months after insertion and to record all bleeding episodes in a menstrual diary specifically provided for this purpose. Satisfaction of the women with each contraceptive method was evaluated 12 months after initial use by a questionnaire. No significant differences between the groups or between the 3 contraceptives were found for discontinuation rates due to unpredictable menstrual bleeding. Cumulative discontinuation rates at 1 year due to menstrual bleeding irregularities for the ENG implant, the LNG-IUS, and the TCu380A IUD users were 2.1%, 2.7%, and 4.0%, respectively; continuation rates were 82.6%, 81.0%, and 73.2%. The primary reason for discontinuation was weight gain in users of the ENG implant and expulsion in users of the TCu380A. These data indicate that routine counseling is as effective as intensive counseling in reducing premature discontinuation rates, improving continuation rates, and achieving high satisfaction among new users of LARC methods. However, these findings should be interpreted with caution. The results may not apply to other settings, and premature discontinuation due to menstrual bleeding was already low. Moreover, some women could be discouraged by counseling from using the LARC methods and could decide to use other contraceptives.