An Estimation of the Risk of Pseudotumor Cerebri among Users of the Levonorgestrel Intrauterine Device

Valenzuela, Reuben; Rai, Ruju; Kirk, Brian; Sanders, Jessica N.; Sundar, Subhashree; Hamann, Steffen; Warner, Judith E. A.; Digre, Kathleen B.; Crum, Alison V.; Jones, Kirtly Parker; Katz, Bradley J.

doi:10.1080/01658107.2017.1304425

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…The results from some of these studies were underpowered because of a small number of events [1,2,12], leading to wide CIs. Other studies did not control for all potential confounders including age and BMI [5,6]. One study [6] undertook a descriptive study where two sets of controls, one from Utah and one from Denmark, were used to generate ORs [7.70 (95% CI 3.7–16.0) and 3.91 (95% CI 1.89–8.06, respectively, for Utah and Danish controls].…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

Etminan

Khosrow‐Khavar

Sodhi

et al. 2020

Euro J of Neurology

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Background and purpose There is a lack of comparative safety data on the risk of pseudotumor cerebri syndrome (PTCS) associated with different hormonal contraceptives. We sought to quantify the risk of PTCS associated with eight different types of hormonal contraceptives compared with oral levonorgestrel. Methods We conducted a retrospective cohort study, with a case–control analysis of 4 871 504 women aged 15–45 years in the period 2008–2015, using IQVIA Ambulatory Electronic Medical Records data in the USA. Patients who used nine different contraceptive agents including intrauterine levonorgestrel, medroxyprogesterone injection, etonogestrel/ethinyl estradiol vaginal ring and combination oral contraceptives (COCs) that contained ethinyl estradiol and the progestins levonorgestrel, norgestimate, desogestrel, norethindrone and drospirenone, were included. Diagnosis of PTCS was defined using the first International Classification of Diseases, 9th or 10th revision, code for intracranial hypertension in patients who had also received an imaging code in the 30 days prior to the index date. Results A total of 3323 PTCS cases and 13 292 matched controls were identified. No increase in risk was found when analysing intrauterine levonorgestrel or COCs containing desogestrel, norethindrone, drospirenone, norgestimate or norgestrel versus COC levonorgestrel. The adjusted incidence rate ratio for etonogestrel/etonogestrel/ethinyl estradiol vaginal ring and medroxyprogesterone suspension compared with levonorgestrel COC was 4.45 [95% confidence interval (CI) 1.98–9.96] and 2.20 (95% CI 1.33–3.64), respectively. Conclusions This study found an elevated risk for PTCS among users of etonogestrel vaginal ring and medroxyprogesterone suspension when compared with oral levonorgestrel. Future studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

Etminan

Khosrow‐Khavar

Sodhi

et al. 2020

Euro J of Neurology

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“…Idiopathic intracranial hypertension (IIH) is a condition of unclear etiology that typically occurs in young, obese women in the reproductive years, which causes headaches, papilledema, and possible vision loss. 1–5 Some prior studies, largely consisting of case reports, 6–10 suggest a link between oral contraceptive pills (OCPs) and an increased risk of intracranial hypertension, 7, 8, 11–15 while other studies have not shown this association. 2, 16–19 There are also a few studies suggesting a possible association between IIH and non-OCP hormonal contraceptives, such as the levonorgestrel intrauterine device (IUD), contraceptive implants, and medroxyprogesterone.…”

Section: Introductionmentioning

confidence: 99%

“…2, 16–19 There are also a few studies suggesting a possible association between IIH and non-OCP hormonal contraceptives, such as the levonorgestrel intrauterine device (IUD), contraceptive implants, and medroxyprogesterone. 6, 9–11, 15, 20, 21 The connection between hormonal contraceptives and IIH, therefore, remains controversial among clinicians and the general public. Any study evaluating the connection between hormonal contraceptives and IIH must take into account possible bias from the demographics of the disease, since women of childbearing age are the most likely population to use contraceptives.…”

Section: Introductionmentioning

confidence: 99%

A Population-Based, Case-Control Evaluation of the Association Between Hormonal Contraceptives and Idiopathic Intracranial Hypertension

Kilgore

Lee

Leavitt

et al. 2019

American Journal of Ophthalmology

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Purpose To determine if the use of oral contraceptive pills (OCP) and other hormonal contraceptives are associated with a higher incidence of idiopathic intracranial hypertension (IIH). Design Retrospective, population-based, case-control study Methods Setting Female IIH patients evaluated between January 1, 1990 and December 31, 2016 were identified using the Rochester Epidemiology Project (REP), a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota, residents. Study Population Fifty-three female residents of Olmsted County diagnosed with IIH between 15 and 45 years of age. The use of OCPs and other hormonal contraceptives was compared to controls matched for age, sex and body-mass index. Interventions/Exposures Hormonal contraceptives Main Outcome Measure Odds of developing IIH Results Of the 53 women diagnosed with IIH between 15 and 45 years of age, 11 (20.8%) had used hormonal contraceptives within ≤30 days of the date of IIH diagnosis, in contrast to 30 (31.3%) among the control patients. The odds ratio of hormonal contraceptive use and IIH was 0.55 (95% CI: 0.24–1.23, p=0.146). The odds ratio of OCP use was 0.52 (95% CI: 0.20–1.34, p=0.174). Conclusions OCP and other hormonal contraceptives were not significantly associated with a higher incidence of IIH, arguing against the need for women with IIH to discontinue their use.

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“…21,22 One recent descriptive study demonstrated an increase in risk with intrauterine levonorgestrel (IL) and PTCS. 23 The study used data from Utah and Denmark and showed an increased odds ratio of 7.70 (95% CI: 3.7-16.0) and 3.91 (95% CI: 1.89-8.06). 23 One limitation of the study was difficulty discerning the timing of the onset of PTCS in relation to IL use.…”

Section: Discussionmentioning

confidence: 99%

Risk of Pseudotumor Cerebri Syndrome (PTCS) with hormonal contraceptive use

Sodhi

Sheldon

Carleton

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Hormonal contraceptives (HC), one of the most prescribed classes of medication in women, have been linked with pseudotumor cerebri syndrome (PTCS). To date, no large epidemiologic study has examined this association.Methods: A case-control study using the IMS LifeLink Pharmetrics Plus database was conducted. Cases had an ICD-9-CM code for benign intracranial hypertension as well as a procedural code for a CT or MRI and a code for lumbar puncture procedure within 15 days of the PTCS code. Controls were selected from the cohort using density-based sampling.Results: From a cohort of 9,053,240 subjects, there were 288 cases of PTCS corresponding to 2,880 controls. The adjusted RRs for two or more prescriptions of oral combined contraceptive was 0.62 (95% confidence interval 0.39-0.99). RRs for overall HC use was 0.91 (95% CI 0.39-2.12) for one prescription of HCs and 0.69 (95% CI 0.45-1.05) for two or more prescriptions. The RRs for one and two or more prescriptions of progestin only HCs were 0.75 (95% CI 0.08-7.46) and 1.06 (95% CI 0.42-2.69), respectively.Conclusions: Overall HC use does not have a significant effect on incidence of PTCS, however harm associated with progestin-only contraceptives cannot be excluded.

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An Estimation of the Risk of Pseudotumor Cerebri among Users of the Levonorgestrel Intrauterine Device

Cited by 9 publications

References 16 publications

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

Pseudotumor cerebri syndrome with different types of hormonal contraceptives in women of child‐bearing age

A Population-Based, Case-Control Evaluation of the Association Between Hormonal Contraceptives and Idiopathic Intracranial Hypertension

Risk of Pseudotumor Cerebri Syndrome (PTCS) with hormonal contraceptive use

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