Champaneria, R., Mamprin DAndrea, R., & Latthe, P. (2016). Hormonal contraception and pelvic floor function: a systematic review. International urogynecology journal, 27(5), 709-722. https://doi.org/10.1007/s00192-015-2833-3
Champaneria R, Mamprin DAndrea R, Latthe P. Hormonal contraception and pelvic floor function: a systematic review. Int Urogynecol J. 2016;27(5):709-722. doi:10.1007/s00192-015-2833-3
Champaneria, Rita, et al. "Hormonal contraception and pelvic floor function: a systematic review." International urogynecology journal, vol. 27, no. 5, 2016, pp. 709-722.
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Hormonal contraceptive use is common practice worldwide. Although the effects of hormone treatments in the pelvic region are well established, there is no clear evidence regarding their effects on incontinence, bladder, bowel, vaginal and sexual symptoms in premenopausal women. We hypothesized that hormonal contraceptives affect pelvic floor function. We therefore performed a comprehensive systematic review of published studies to determine the influence of hormonal contraception on pelvic floor functions.
Methods
Electronic literature databases were searched from database inception to March 2015. Keywords and medical subject headings searched for included terms and word variations for 'contraception', and 'bowel', 'vaginal', 'sexual' and 'urinary' symptoms. Studies were eligible if they looked at these symptoms in women taking hormonal contraception. Two reviewers independently screened studies for inclusion, and extracted data on study characteristics, quality and results. Data were combined where possible.
Results
Of the 429 citations identified, 13 studies were included in the review. Data were meta-analysed where possible and presented as prevalence. The results indicate statistically significant links between interstitial cystitis and oral contraceptive use at any point (ever) (OR 2.31, 95 % CI 1.03 - 5.16; p = 0.04) and vulvar vestibulitis and current oral contraceptive use (OR 2.10, 95 % CI 1.26 - 3.49; p = 0.004). The evidence is unclear in other areas.
Conclusions
Our results indicate that oral contraceptives may have an effect on pelvic floor function. They could increase the risk of painful bladder and vulvar vestibulitis, but their effect on dyspareunia is inconsistent. However, robustly collected prospective data to establish causal associations are needed.
Mosorin ME et al., 2023·J Clin Med·Free full text on PubMed Central
This clinical trial aims to compare hormonal and metabolic changes after a 9-week continuous use of oral or vaginal combined hormonal contraceptives (CHCs) in women with polycystic ovary syndrome (PCOS). We recruited 24 women with PCOS and randomized them to use either combined oral (COC, n = 13) or vaginal (CVC, n = 11) contraception. At baseline and 9 weeks, blood samples were collected and a 2 h glucose tolerance test (OGTT) was performed to evaluate hormonal and metabolic outcomes. After treatment, serum sex hormone binding globulin (SHBG) levels increased (p < 0.001 for both groups) and the free androgen index (FAI) decreased in both study groups (COC p < 0.001; CVC p = 0.007). OGTT glucose levels at 60 min (p = 0.011) and AUCglucose (p = 0.018) increased in the CVC group. Fasting insulin levels (p = 0.037) increased in the COC group, and insulin levels at 120 min increased in both groups (COC p = 0.004; CVC p = 0.042). There was a significant increase in triglyceride (p < 0.001) and hs-CRP (p = 0.032) levels in the CVC group. Both oral and vaginal CHCs decreased androgenicity and tended to promote insulin resistance in PCOS women. Larger and longer studies are needed to compare the metabolic effects of different administration routes of CHCs on women with PCOS.
Battaglia C et al., 2012·The Journal of Sexual Medicine
Oral contraceptives (OCs) induce mood and libido changes. The aim of this study was to evaluate in young, eumenorrheic, healthy women the sexual behavior and the genital vascular effects of an OC containing 30 µg ethinylestradiol (EE) and 3 mg drospirenone (DRSP). The main outcome measures are McCoy Female Sexuality Questionnaire (MFSQ), the labia minora thickness and vaginal introitus area, the pulsatility index (PI) of clitoral and labia minora arteries, and hormonal and biochemical assays. Twenty-two adult, eumenorrheic, healthy women were administered the two-factor Italian MFSQ. The labia minora thickness was studied by two-dimensional ultrasonographic, and the clitoral and labia minora arteries were evaluated by color Doppler; three-dimensional static volumes of the vulvar area were calculated. Hormonal (estradiol, androstenedione, and testosterone) and biohumoral (sex hormone binding globulin) parameters were assayed. Subjects were studied in baseline conditions and after 3 months of therapy with an OC (Yasmin®, Bayer-Schering Italia, Milan, Italy; −30 µg EE + 3 mg DRSP). After 3-month treatment, the labia minora thickness and the vaginal introitus area significantly decreased in comparison with the baseline values, whereas the PI of the dorsal clitoral artery and the posterior labial artery significantly increased. The OC use induced a significant decrease of the two-factor Italian MFSQ score, a reduction of the number of intercourse/week, and a reduction of the frequency of orgasm during intercourse. The item 18 (pain during intercourse) worsened after OC. The treatment with Yasmin® (Bayer-Schering Italia) is associated with increased pain during intercourse, with decreased libido and spontaneous arousability, and with diminished frequency of sexual intercourse and orgasm.
Thompson A et al., 2020·Cureus·Free full text on PubMed Central
It has been well documented that female sex is a significant risk factor for the development of various autoimmune diseases. While the reason for this has been debated, one well-regarded theory is that increased estrogen and decreased testosterone play a role in this predisposition. Interstitial cystitis (IC), also known as painful bladder syndrome (PBS), is an autoimmune disorder that affects over nine million women in the United States. It presents with pelvic and bladder pain and urinary symptoms, both of which significantly and negatively affect the quality of life. Even so, very few studies have examined the pathophysiologic relationship between autoimmune disorders and hormonal contraceptives. In this report, we present a case of IC likely precipitated by oral contraceptives (OCPs) in a premenopausal female. Shortly after beginning OCPs, this patient developed symptoms of severe pelvic pain and increased urinary frequency. Over the course of a year, the patient was diagnosed and treated for a variety of conditions, such as urinary tract infection (UTI), fungal vaginitis, and nephrolithiasis. After consultation with a gynecologist, a normal abdominal CT scan, and unsuccessful cystoscopy due to pain, she was finally diagnosed with IC. The patient independently learned of a potential link between hormonal contraceptive pills and IC and decided to discontinue this method of birth control. Following this, her symptoms completely resolved within several months. The timing of her initiation and discontinuation of OCPs, alongside her symptomatology, suggest a connection to the development of IC. A literature review was performed, which supports this association. We, therefore, highlight this case as an important example of IC precipitated by OCPs.
Chronic Pain and Bladder Syndromes · Interstitial Cystitis
Dyspareunia and sexual dysfunction are common in women with urological disorders. The study of comorbidity between interstitial cystitis (IC) and vulvodynia seems to be relevant to understand the mechanism generating pain in these conditions. To conduct a case-control study for evaluating vulvodynia and sexual dysfunction in women with IC. Forty-seven women with new diagnosis (National Institutes of Health [NIH]/National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] Criteria) of IC were compared with 188 age-matched, negative controls. Each woman completed a semi-structured interview and the Female Sexual Function Index (FSFI). A gynecological examination to assess vulvodynia (cotton swab testing) and genital health (vulvoscopy, Pap smear, culture, and vaginal health index score [VHIS]) was performed. Prevalence of vulvodynia, sexual function, and sociodemographic/gynecological variables significantly associated with IC. Spontaneous or provoked vulvodynia was reported by 23.4% and 74.5% of IC cases, respectively. Sexual function was significantly impaired (median total FSFI score: IC cases 16.85 ± 8.73 vs. controls 27.34 ± 6.41; P<0.0001) in sexually active women, and 23.4% of IC cases as compared to 9% of controls reported no sexual activity in the year preceding the study (χ(2) for trend=38.2, P<0.0001). VHIS was highly impaired in women with IC in comparison with controls (P<0.0001). Variables significantly associated with IC were a diagnosis of menopause (odds ratio [OR]=31.2, 95% confidence interval [CI]=8.1-120.5), past (OR=4.6, 95% CI=1.74-12.1) or current (OR=6.9, 95% CI=2.1-22.1) oral contraceptive use, and a histologically confirmed diagnosis of endometriosis (OR=3.7, 95% CI=1.1-12.7). We found an increased prevalence of vulvodynia among women with recently diagnosed IC; both conditions seem to have profound consequences on women's sexual function. A potential role for sex hormone-dependent mechanisms into the comorbidity of vulvar and bladder pain is proposed, but further research is warranted.
PMID 26407563 26407563 DOI 10.1007/s00192-015-2833-3 10.1007/s00192-015-2833-3 Champaneria et al. 2015, Champaneria 2015
Cite this article
Champaneria, R., Mamprin DAndrea, R., & Latthe, P. (2016). Hormonal contraception and pelvic floor function: a systematic review. International urogynecology journal, 27(5), 709-722. https://doi.org/10.1007/s00192-015-2833-3
Champaneria R, Mamprin DAndrea R, Latthe P. Hormonal contraception and pelvic floor function: a systematic review. Int Urogynecol J. 2016;27(5):709-722. doi:10.1007/s00192-015-2833-3
Champaneria, Rita, et al. "Hormonal contraception and pelvic floor function: a systematic review." International urogynecology journal, vol. 27, no. 5, 2016, pp. 709-722.
