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Kenneth F Schulz - One of the best experts on this subject based on the ideXlab platform.
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Oral Contraceptives for functional ovarian cysts
Cochrane Database of Systematic Reviews, 2014Co-Authors: David A Grimes, Lashawn Jones, Laureen M Lopez, Kenneth F SchulzAbstract:Background Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early Oral Contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. Objectives This review examined all randomized controlled trials that studied Oral Contraceptives as therapy for functional ovarian cysts. Search methods In March 2014, we searched the databases of CENTRAL, PubMed, EMBASE, and POPLINE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles. For the initial review, we wrote to authors of identified trials to seek articles we had missed. Selection criteria We included randomized controlled trials in any language that included Oral Contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials. Data collection and analysis Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio with 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference with 95% CI. Main results We identified eight randomized controlled trials from four countries; the studies included a total of 686 women. Treatment with combined Oral Contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. Authors' conclusions Although widely used for treating functional ovarian cysts, combined Oral Contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.
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nonspecific side effects of Oral Contraceptives nocebo or noise
Contraception, 2011Co-Authors: David A Grimes, Kenneth F SchulzAbstract:Side effects of combined Oral Contraceptives are the most common reason why women discontinue them. Over the past half century, an elaborate mythology about these ill effects has evolved, fueled by rumor, gossip and poor-quality research. In contrast, placebo-controlled randomized trials document that nonspecific side effects are not significantly more common with combined Oral Contraceptives than with inert pills. These reported nonspecific side effects may reflect the nocebo phenomenon (the inverse of a placebo): if women are told to expect noxious side effects, these complaints occur because of the power of suggestion. Alternatively, nonspecific complaints may simply reflect their background prevalence in the population. Because Level I evidence documents no important increase in nonspecific side effects with Oral Contraceptives, counseling about these side effects or including them in package labeling is unwarranted and probably unethical. When in doubt, clinicians should err on the side of optimism.
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Oral Contraceptives for functional ovarian cysts
Obstetrics & Gynecology, 2009Co-Authors: David A Grimes, Lashawn Jones, Laureen M Lopez, Kenneth F SchulzAbstract:BACKGROUND: Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early Oral Contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. OBJECTIVES: This review examined all randomized controlled trials that studied Oral Contraceptives as therapy for functional ovarian cysts. SEARCH STRATEGY: We searched the databases of CENTRAL, MEDLINE, POPLINE, and EMBASE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles and wrote to authors of identified trials to seek articles we had missed. SELECTION CRITERIA: We included randomized controlled trials in any language that included Oral Contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we used Peto odds ratios with 95% confidence intervals (Cls). For continuous outcomes, we calculated mean differences with 95% CI. MAIN RESULTS: We identified seven randomized controlled trials from four countries; the studies included a total of 500 women. Treatment with combined Oral Contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. AUTHORS' CONCLUSION: Although widely used for treating functional ovarian cysts, combined Oral Contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.
F. R. Rosendaal - One of the best experts on this subject based on the ideXlab platform.
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combined Oral Contraceptives venous thrombosis
Cochrane Database of Systematic Reviews, 2014Co-Authors: Marcos De Bastos, F. R. Rosendaal, Bernardine H Stegeman, Astrid Van Hylckama Vlieg, Frans M Helmerhorst, Theo Stijnen, Olaf M DekkersAbstract:Background Combined Oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. Objectives To provide a comprehensive overview of the risk of venous thrombosis in women using different combined Oral Contraceptives. Search methods Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. Selection criteria We selected studies including healthy women taking COC with VT as outcome. Data collection and analysis The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. Main results 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined Oral Contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined Oral Contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined Oral Contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. Authors' conclusions All combined Oral Contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol. Risk of venous thrombosis for combined Oral Contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate and drospirenone were similar, and about 50-80% higher than with levonorgestrel. The combined Oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed—that is, 30 μg ethinylestradiol with levonorgestrel.
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risk of arterial thrombosis in relation to Oral Contraceptives ratio study Oral Contraceptives and the risk of ischemic stroke
Stroke, 2002Co-Authors: Jeanet M Kemmeren, F. R. Rosendaal, Frans M Helmerhorst, Bea C Tanis, Maurice A A J Van Den Bosch, Edward L E M Bollen, Yolanda Van Der Graaf, Ale AlgraAbstract:Background and Purpose— Epidemiological studies have shown an increased risk of venous thrombosis in women taking third-generation Oral Contraceptives, ie, those containing the progestogens desogestrel or gestodene. This study assesses the risk of ischemic stroke with several types of Oral Contraceptives. Methods— A multicenter, population-based, case-control study was performed in 9 Dutch centers in women aged 18 to 49 years. Women with a first ischemic stroke were compared with control women without vascular diseases. The control subjects were recruited by random-digit dialing and were stratified by age, area of residence, and year of stroke. All patients and control subjects filled in a questionnaire about the use of Oral Contraceptives and risk factors for ischemic stroke. Odds ratios were adjusted for the stratification factors. Results— Two hundred three women with an ischemic stroke and 925 control women were included. The risk of stroke in women using any type of Oral Contraceptives versus none wa...
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Oral Contraceptives and the risk of venous thrombosis
The New England Journal of Medicine, 2001Co-Authors: Jan P. Vandenbroucke, Jan Rosing, Kitty W. M. Bloemenkamp, Frans M Helmerhorst, Saskia Middeldorp, B N Bouma, F. R. RosendaalAbstract:In the early 1960s, shortly after the introduction of Oral Contraceptives, the first case reports appeared describing venous thrombosis and pulmonary emboli in women using this method of birth control. Later, myocardial infarction and stroke were also found to be associated with the use of Oral Contraceptives. These observations led to numerous epidemiologic and clinical studies of Oral-contraceptive pills and thrombosis and subsequently to the development of new Oral Contraceptives with a lower estrogen content. These lower-estrogen Contraceptives were considered safer: changes in hemostatic factors remained small, inconsistent in direction, and mostly within the normal range.1–4 Recent studies have . . .
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Venous thromboembolism and Oral Contraceptives [letter]
The Lancet, 1999Co-Authors: Kitty W. M. Bloemenkamp, F. R. Rosendaal, Jan P. VandenbrouckeAbstract:This paper comments on a study conducted by Herings and colleagues confirming the difference in venous thromboembolism risk between second and third generation Oral Contraceptives. The conclusion derived by Herings and colleagues relating the interaction between Oral contraceptive use and factor V Leiden leading to venous thrombosis development served as a guide to reanalyze other study results. One study analyzed data for the type of Oral Contraceptives and found out that the age-adjusted relative risk for the desogestrel-containing Oral contraceptive was 9.2 among non-carriers of factor V Leiden mutation and 6.0 among carriers. Furthermore the risk for venous thrombosis is highest during initial Oral contraceptive use which suggests that some women are at immediate risk of thrombosis when exposed to Oral Contraceptives. Data of the Leiden Thrombophilia Study was reanalyzed and led to the classification of women as thrombophilic when they had deficiencies of protein C protein S or antithrombin or mutations in factor V Leiden or prothrombin 20210A. Therefore the variation in susceptibility in each woman is a key answer why Oral Contraceptives cause venous thrombosis.
Diana B Petitti - One of the best experts on this subject based on the ideXlab platform.
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combination estrogen progestin Oral Contraceptives
The New England Journal of Medicine, 2003Co-Authors: Diana B PetittiAbstract:A healthy, sexually active, 35-year-old woman presents for advice about the use of Oral Contraceptives. She does not smoke cigarettes and has no personal or family history of venous thromboembolism, myocardial infarction, or stroke. Her blood pressure is 120/80 mm Hg. Should an Oral contraceptive be prescribed, and if so, how should a formulation be chosen?
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stroke in users of low dose Oral Contraceptives
The New England Journal of Medicine, 1996Co-Authors: Diana B Petitti, Stephen Sidney, Allan L Bernstein, Sheldon M Wolf, Charles P Quesenberry, Harry K ZielAbstract:Background Previous studies have linked the use of Oral contraceptive agents to an increased risk of stroke, but those studies have been limited to Oral Contraceptives containing more estrogen than is now generally used. Methods In a population-based, case–control study, we identified fatal and nonfatal strokes in female members of the California Kaiser Permanente Medical Care Program who were 15 through 44 years of age. Matched controls were randomly selected from female members who had not had strokes. Information about the use of Oral Contraceptives (essentially limited to low-estrogen preparations) was obtained in interviews. Results A total of 408 confirmed strokes occurred in a total of 1.1 million women during 3.6 million woman-years of observation. The incidence of stroke was thus 11.3 per 100,000 woman-years. On the basis of data from 295 women with stroke who were interviewed and their controls, the odds ratio for ischemic stroke among current users of Oral Contraceptives, as compared with forme...
Frans M Helmerhorst - One of the best experts on this subject based on the ideXlab platform.
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combined Oral Contraceptives venous thrombosis
Cochrane Database of Systematic Reviews, 2014Co-Authors: Marcos De Bastos, F. R. Rosendaal, Bernardine H Stegeman, Astrid Van Hylckama Vlieg, Frans M Helmerhorst, Theo Stijnen, Olaf M DekkersAbstract:Background Combined Oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. Objectives To provide a comprehensive overview of the risk of venous thrombosis in women using different combined Oral Contraceptives. Search methods Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. Selection criteria We selected studies including healthy women taking COC with VT as outcome. Data collection and analysis The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. Main results 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined Oral Contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined Oral Contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined Oral Contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. Authors' conclusions All combined Oral Contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol. Risk of venous thrombosis for combined Oral Contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate and drospirenone were similar, and about 50-80% higher than with levonorgestrel. The combined Oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed—that is, 30 μg ethinylestradiol with levonorgestrel.
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risk of arterial thrombosis in relation to Oral Contraceptives ratio study Oral Contraceptives and the risk of ischemic stroke
Stroke, 2002Co-Authors: Jeanet M Kemmeren, F. R. Rosendaal, Frans M Helmerhorst, Bea C Tanis, Maurice A A J Van Den Bosch, Edward L E M Bollen, Yolanda Van Der Graaf, Ale AlgraAbstract:Background and Purpose— Epidemiological studies have shown an increased risk of venous thrombosis in women taking third-generation Oral Contraceptives, ie, those containing the progestogens desogestrel or gestodene. This study assesses the risk of ischemic stroke with several types of Oral Contraceptives. Methods— A multicenter, population-based, case-control study was performed in 9 Dutch centers in women aged 18 to 49 years. Women with a first ischemic stroke were compared with control women without vascular diseases. The control subjects were recruited by random-digit dialing and were stratified by age, area of residence, and year of stroke. All patients and control subjects filled in a questionnaire about the use of Oral Contraceptives and risk factors for ischemic stroke. Odds ratios were adjusted for the stratification factors. Results— Two hundred three women with an ischemic stroke and 925 control women were included. The risk of stroke in women using any type of Oral Contraceptives versus none wa...
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Oral Contraceptives and the risk of venous thrombosis
The New England Journal of Medicine, 2001Co-Authors: Jan P. Vandenbroucke, Jan Rosing, Kitty W. M. Bloemenkamp, Frans M Helmerhorst, Saskia Middeldorp, B N Bouma, F. R. RosendaalAbstract:In the early 1960s, shortly after the introduction of Oral Contraceptives, the first case reports appeared describing venous thrombosis and pulmonary emboli in women using this method of birth control. Later, myocardial infarction and stroke were also found to be associated with the use of Oral Contraceptives. These observations led to numerous epidemiologic and clinical studies of Oral-contraceptive pills and thrombosis and subsequently to the development of new Oral Contraceptives with a lower estrogen content. These lower-estrogen Contraceptives were considered safer: changes in hemostatic factors remained small, inconsistent in direction, and mostly within the normal range.1–4 Recent studies have . . .
David A Grimes - One of the best experts on this subject based on the ideXlab platform.
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Oral Contraceptives for functional ovarian cysts
Cochrane Database of Systematic Reviews, 2014Co-Authors: David A Grimes, Lashawn Jones, Laureen M Lopez, Kenneth F SchulzAbstract:Background Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early Oral Contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. Objectives This review examined all randomized controlled trials that studied Oral Contraceptives as therapy for functional ovarian cysts. Search methods In March 2014, we searched the databases of CENTRAL, PubMed, EMBASE, and POPLINE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles. For the initial review, we wrote to authors of identified trials to seek articles we had missed. Selection criteria We included randomized controlled trials in any language that included Oral Contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials. Data collection and analysis Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio with 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference with 95% CI. Main results We identified eight randomized controlled trials from four countries; the studies included a total of 686 women. Treatment with combined Oral Contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. Authors' conclusions Although widely used for treating functional ovarian cysts, combined Oral Contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.
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nonspecific side effects of Oral Contraceptives nocebo or noise
Contraception, 2011Co-Authors: David A Grimes, Kenneth F SchulzAbstract:Side effects of combined Oral Contraceptives are the most common reason why women discontinue them. Over the past half century, an elaborate mythology about these ill effects has evolved, fueled by rumor, gossip and poor-quality research. In contrast, placebo-controlled randomized trials document that nonspecific side effects are not significantly more common with combined Oral Contraceptives than with inert pills. These reported nonspecific side effects may reflect the nocebo phenomenon (the inverse of a placebo): if women are told to expect noxious side effects, these complaints occur because of the power of suggestion. Alternatively, nonspecific complaints may simply reflect their background prevalence in the population. Because Level I evidence documents no important increase in nonspecific side effects with Oral Contraceptives, counseling about these side effects or including them in package labeling is unwarranted and probably unethical. When in doubt, clinicians should err on the side of optimism.
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Oral Contraceptives for functional ovarian cysts
Obstetrics & Gynecology, 2009Co-Authors: David A Grimes, Lashawn Jones, Laureen M Lopez, Kenneth F SchulzAbstract:BACKGROUND: Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early Oral Contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. OBJECTIVES: This review examined all randomized controlled trials that studied Oral Contraceptives as therapy for functional ovarian cysts. SEARCH STRATEGY: We searched the databases of CENTRAL, MEDLINE, POPLINE, and EMBASE, as well as clinical trials databases (ClinicalTrials.gov and ICTRP). We also examined the reference lists of articles and wrote to authors of identified trials to seek articles we had missed. SELECTION CRITERIA: We included randomized controlled trials in any language that included Oral Contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of trials. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from the articles. One entered the data into RevMan and a second verified accuracy of data entry. For dichotomous outcomes, we used Peto odds ratios with 95% confidence intervals (Cls). For continuous outcomes, we calculated mean differences with 95% CI. MAIN RESULTS: We identified seven randomized controlled trials from four countries; the studies included a total of 500 women. Treatment with combined Oral Contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. AUTHORS' CONCLUSION: Although widely used for treating functional ovarian cysts, combined Oral Contraceptives appear to be of no benefit. Watchful waiting for two or three cycles is appropriate. Should cysts persist, surgical management is often indicated.
