Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.

Objective To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose.Design National historical registry based cohort study. Setting Four registries in Denmark.Participants Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009. Main outcome measures Relative and absolute risks of first time venous thromboembolism.Results Within 8 010 290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10 000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year. ConclusionAfter adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or drospirenone were at least at twice the risk of venous thromboembolism compared with users of oral contraceptives with levonorgestrel. IntroductionThe influence of specific types of combined oral contraceptives on the risk of thrombotic events remains the most important safety issue for these products. Several studies have investigated the relation between combined oral contraceptives and venous thromboembolism, including newer large scale studies. [17][18][19] These new studies showed an increased risk of venous thromboembolism in current users of combined oral contraceptives and a decreasing risk by both time of use and decreasing oestrogen dose. RESEARCHResults on the significance of the type of progestogen differed. Ten studies reported an increased relative risk of venous thromboembolism among users of oral contraceptives with desogestrel or gestodene compared with those containing levonorgestrel, 1 2 4-7 9 13 17 18 a difference that was significant in eight of the...

Although the absolute risks of thrombotic stroke and myocardial infarction associated with the use of hormonal contraception were low, the risk was increased by a factor of 0.9 to 1.7 with oral contraceptives that included ethinyl estradiol at a dose of 20 μg and by a factor of 1.3 to 2.3 with those that included ethinyl estradiol at a dose of 30 to 40 μg, with relatively small differences in risk according to progestin type. (Funded by the Danish Heart Association.).

The risk of breast cancer was higher among women who currently or recently used contemporary hormonal contraceptives than among women who had never used hormonal contraceptives, and this risk increased with longer durations of use; however, absolute increases in risk were small. (Funded by the Novo Nordisk Foundation.).

Introduction. The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis. Material and methods. National cohort including all delivering women and their newborns in Denmark 1997-2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy. Results. In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5-2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk. Conclusion. Women with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance.

Objective To assess the risk of venous thrombosis in current users of non-oral hormonal contraception.Design Historical national registry based cohort study. Setting Four national registries in Denmark.Participants All Danish non-pregnant women aged 15-49 (n=1 626 158), free of previous thrombotic disease or cancer, were followed from 2001 to 2010. Main outcome measuresIncidence rate of venous thrombosis in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception, relative risk of venous thrombosis compared with non-users, and rate ratios of venous thrombosis in current users of non-oral products compared with the standard reference oral contraceptive with levonorgestrel and 30-40 µg oestrogen. Diagnoses were confirmed by at least four weeks of anticoagulation therapy after the diagnosis.Results Within 9 429 128 woman years of observation, 5287 first ever venous thrombosis events were recorded, of which 3434 were confirmed. In non-users of hormonal contraception the incidence rate of confirmed events was 2.1 per 10 000 woman years. Compared with non-users of hormonal contraception, and after adjustment for age, calendar year, and education, the relative risk of confirmed venous thrombosis in users of transdermal combined contraceptive patches was 7.9 (95% confidence interval 3.5 to 17.7) and of the vaginal ring was 6.5 (4.7 to 8.9). The corresponding incidences per 10 000 exposure years were 9.7 and 7.8 events. The relative risk was increased in women who used subcutaneous implants (1.4, 0.6 to 3.4) but not in those who used the levonorgestrel intrauterine system (0.6, 0.4 to 0.8). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk of venous thrombosis in users of transdermal patches was 2.3 (1.0 to 5.2) and of the vaginal ring was 1.9 (1.3 to 2.7). ConclusionWomen who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non-users of hormonal contraception of the same age, corresponding to 9.7 and 7.8 events per 10 000 exposure years. The risk was slightly increased in women using subcutaneous implants but not in those using the levonorgestrel intrauterine system. IntroductionSeveral studies have assessed the risk of venous thrombosis in women using oral contraceptives.1-10 However, none has assessed the risk in women using subcutaneous hormonal implants. A recent study reported a 48% higher risk of venous thrombosis in women using a vaginal ring compared with those using combined oral contraceptives containing levonorgestrel, 11 and a few studies have reported the risk in women using a transdermal combined contraceptive patch, although the results were conflicting. 12-16Using a historical national registry based cohort study design, we assessed the absolute and relative risk of venous thrombosis in Danish women using non-oral hormonal contraception. MethodsInformation on the four national data sources that provided information for th...

The functional results and sexuality were evaluated using 2 standardized questionnaires, FSFI and FSDS-R. Questions were added to analyze depression, body image perception, and desire of motherhood.The authors found that of the 68% of patients who responded to the questionnaire, 73% had regular sexual intercourse. The mean FSFI score was 28 T 3.1 in the operated group and 30 T 5.3 in the group treated with the Frank method. The mean FSDS-R scores were 21 T 12.1 and 18 T 13.8, respectively.The authors concluded that sigmoid vaginoplasty is an effective technique providing a nearly normal sexual function to patients with vaginal aplasia. Although true, the psychological distress related to sexuality persists in most patients, which speaks to the need for multidisciplinary support.The MRKH etiology remains unclear, and the diagnosis is usually established during adolescence. The first clinical sign is primary amenorrhea, while the remainder of the puberty development is otherwise normal.In the sigmoid vaginoplasty group, 3 patients had sexual intercourse, and another patient only partly answered the questionnaire, making the FSDS-R as the only score interpretable. Three patients had never had sexual intercourse, and the other had not been sexually active for several years. The investigators mentioned that among the 30 others, 22 had regular sexual intercourse at least 2 or 3 times per week. The mean time before the first sexual relation after surgery was 7 months (range, 1Y42 months). The mean FSDS-R score was 21. Only 15% had a score less than 11, indicating the absence of anxiety related to sexuality. Twentyone patients (70%) had a score greater than 26.55.As demonstrated in this study, the MRKH syndrome results in a multitude of very difficult physical and emotional problems.VRBJ) ABSTRACT Several studies published in the past 10 years have evaluated the risk of venous thromboembolic complications with the use of newer hormonal contraceptives, but few have examined the risk of thrombotic stroke and myocardial infarction. Results of the few available studies have been conflicting.The aim of the Danish historical cohort study was to assess the risks of thrombotic stroke and myocardial infarction among women who received various types of hormonal contraception. Over a 15-year period (1995Y2009), data were obtained on use of hormonal contraception, clinical end points, and potential confounders from national registries for nonpregnant women, 15 to 49 years old, who had no history of cardiovascular disease or cancer. Data on contraceptives were stratified according to estrogen dose, progestin, and route of administration. The crude incidence rate and adjusted relative risk (RR) of thrombotic events were compared in users of contraceptives and nonusers.The study cohort was composed of 1,626,158 women with 14,251,063 person-years of observation. Among this population, 3311 had a first thrombotic stroke (21.4 per 100,000 person-years), and 1725 had a first myocardial infarction (10.1 per 100,000 person-years). Relative r...

Use of hormonal contraception was positively associated with subsequent suicide attempt and suicide. Adolescent women experienced the highest relative risk.