News Highlights
Obesity may decrease the effectiveness of contraceptives
Hormonal contraception is almost twice as likely to fail in women who are overweight and obese.A survey of 18,000 women in the U.S. that assessed body weight and unintended pregnancies found the odds of getting pregnant while taking hormonal contraception increased by a factor of 1.73 in women with a higher body mass index (BMI of 25 or more) compared to women with what is considered normal body weight (a BMI below 25). A woman can easily calculate her BMI using this tool on the Health Canada website.
Weight was not a factor affecting the pregnancy rates among women who were not using hormonal contraception. This supports the idea that unintended pregnancies were due to the contraceptive failure, and not merely being overweight.
These results are not conclusive, but considering the obesity epidemic, they speak to the need to further study the impact obesity on the effectiveness of contraceptives. Ideally, non-pregnant women using oral contraceptives need to be identified and followed over time to confidently assess contraceptive failure rates, and to control for the variables that could bias results.
1. Brunner Huber LR and Hogue CJ. The Association Between Body Weight, Unintended Pregnancy Resulting in a Livebirth, and Contraception at the Time of Conception. Maternal and Child Health Journal 2005;9(4):413-20.
http://www.statcan.ca/english/research/82-620-MIE/2005001/articles/adults/aobesitybmi.htm
Having one sexually transmitted infection puts you at risk of another
Women who have been treated for sexually transmitted infections (STIs) should be retested in three months to screen for reinfection, even if they have no symptoms, according to new guidelines for health professionals.
The antibiotics used to treat infections like Gonorrhea and Chlamydia are so effective that the guidelines published in recent years stopped recommending that people be tested after being treated. But studies have since shown that even though cure rates are excellent, there are significant rates of reinfection rather than persistent infection.
A new study examined people recruited from STI clinics who were enrolled in an HIV prevention counseling study for rates of STI reinfection within one year of their original diagnosis.
Every three months, 1236 women and 1183 men were tested for various infections including gonorrhea, trichomonas, and Chlamydia. Within one year, 25.8% of women and 14.7% of men had at least one new infection. Two-thirds of these patients had no symptoms related to their infection, a figure that is consistent with the results from other studies.
The authors believe that some infections may have been due to treatment failure. Others may be due to partners who were not treated, or the patients being part of a sexual network that acts as a reservoir for infection and reinfection. The majority of these STIs had no symptoms, making it more likely that these individuals would pass them on because they are not aware of them.
Undetected STIs can result in future fertility problems. Even when women have no symptoms, infection places them at risk of pelvic inflammatory disease. This can lead to scarring of the fallopian tubes, followed by infertility or ectopic pregnancy—a complication where the fertilized ovum develops outside the wall of the uterus. Models have shown that it may be cost-effective to screen women aged 15-29 every six months if they have previously had an infection with Chlamydia.
Patients diagnosed with STIs need to be advised that they are at risk for reinfection and should be retested to detect any new STIs. With knowledge of the long-term impacts of having an untreated STI, people should also be encouraged to prevent passing infections by having partners treated, and by practicing safer sex with condoms and other barrier methods.
High Incidence of New Sexually Transmitted Infections in the Year following a Sexually Transmitted Infection: A Case for Rescreening. Peterman TA, Tian LH, Metcalf CA, Satterwhite CL, Malotte CK, DeAugustine N, Paul SM, Cross H, Rietmeijer CA, Douglas JM. Ann Intern Med. 2006;145:564-572.
Periods and fertility return to most oral contraception users a month after stopping
A new study has looked at the length of time it takes women to return to normal menstrual cycles after using continuous-use birth control pills for at least six months—a new brand of oral contraceptive that is taken every day without a break.
Lybrel® is a continuous-use pill approved by the Food and Drug Administration (FDA) that is available in the United States. It is similar to other oral contraceptives in that it contains the hormones estrogen and progestin. The big difference is that it is made to be taken every day of the year with no days off, and no days of placebo or inactive pills.
All of the women in the study had regular periods before they started taking this continuous-use pill. Within three months of stopping, 98.9% of the 187 women studied had either resumed periods or become pregnant. Thirty-two days was the usual time it took for periods to return after the last pill was taken, the equivalent of one menstrual cycle.
Conventional oral contraceptive pills are taken for three weeks followed by one week of inactive pills or no pills, when a period is expected to occur due to withdrawal of the hormones. Although this conventional approach to oral contraceptives appears to mimic the natural 28 day menstrual cycle by giving women monthly periods there is no real advantage. For many women, considerable distress accompanies the monthly flow, either due to heavy menstruation or severe cramps.
Since the mid ‘70s, doctors have been prescribing off-label continuous, also called extended cycle use, hormonal contraception so women can avoid menstruation at key times, such as during travel or honeymoons. This continuous regimen is a more formal approach, for women who find menstruation distressing and prefer to avoid it altogether.
Many women who took Lybrel® for the study became amenorrheic—in other words, they had no periods—something to expect on a continuous pill like this. The time it took them to return to normal cycles was not affected by the length of time they went without having periods. Women who ovulate and menstruate regularly rapidly return to fertility after they stop using a continuous-use pill, even after months of amenorrhea.
Click for more information on controlling your periods with contraception.
Davis AR, Kroll R, Soltes B, Zhang N, Grubb GS, Constantine GD. Occurrence of menses or pregnancy after cessation of a continuous oral contraceptive. Fertil Steril,In Press, Corrected Proof, Available online 20 July 2007.
International Day Against Homophobia
May 17th is International Day Against Homophobia (IDAH). The theme this year is "Homosexuality is NOT a sickness", with the aim of removing the stigma and discrimination against GLBT individuals from healthcare environments—a key to reducing the spread of sexually transmitted infections.
For more information on IDAH, visit www.homophobiaday.org.
Ask Sexualityandu
Does the birth control pill cause gall bladder problems?
Although the birth control pill may worsen pre-existing gall bladder disease, like gall bladder attacks secondary to gall stones, it does not cause gall bladder disease. It may appear that it is the cause if it unmasks disease which may have been present before, but may not have been symptomatic before.
Do healthcare plans cover any cost associated with reversing a tubal ligation? Is it a standard procedure at most hospitals? What is the cost?
Health care plans do not cover any costs for a tubal ligation reversal in most jurisdictions. The availability of the procedure would depend on the hospital as not all obstetrician/gynaecologists are trained to do this procedure. You would have to ask your physician what is available. The success rates depend on what method of tubal ligation was used for the original procedure and how much tube length is left. The costs vary between hospitals and provinces, but it would be approximately $5000-$7000 to cover fees for the anaesthesiologist, the surgeon and the facility.
I’m using NuvaRing® – I was wondering, can it be inserted wrong even though it’s already inside?
The Nuva-ring® cannot be inserted wrong and it cannot end up in the wrong place. It only needs to be placed high enough in the vagina so that it will not fall out and you will not be aware of its presence. The inside of the vagina is actually a closed area, so the ring cannot get lost inside. In general, male sexual partners do not notice the ring or are not bothered by it.
Can the menstrual cup enlarge or stretch the vagina?
The vagina is muscular with a highly variable capacity and will not be enlarged or stretched by the menstrual cup. Click to read more on menstrual management options.
