The European Journal of Contraception & Reproductive Health Care

Association of intrauterine device use and risk of abnormal cervical cytology

To determine whether intrauterine device (IUD) use is associated with a significantly increased risk of abnormal cervical cytology. A retrospective cohort study was carried out at the University of Campinas, Campinas, SP, Brazil. Data came from medical records of 2,963 women from a family planning clinic who had undergone at least one cervical cytology for screening between 1990 and 2017. Women were split into three groups: users of either copper (Cu)- or the levonorgestrel 52 mg-IUD (2,305) and users of other contraceptive methods (658). The dependent variable was the cytological results as normal and abnormal, based on the Bethesda System. The most severe cytological result of each participant was considered and when all her results were normal, the last one was considered. IUD use was associated with a lower risk of abnormal cervical cytology after adjusting for the number of cytology assessments per participant (RR 0.74; 95% CI 0.55;0.99; We identified low risk of abnormal cervical cytology among IUD users.

Sequential treatment with relugolix combination therapy in women with symptomatic uterine fibroids that were inadequately managed with 52 mg levonorgestrel intrauterine system: the first report

This is the first report aimed to evaluate the clinical impact and safety of sequential treatment with relugolix combination therapy (relugolix CT) in women with symptomatic uterine fibroids that were inadequately managed with 52 mg levonorgestrel intrauterine system (LNG-IUS) monotherapy. The patients included four women aged 45-52 (mean: 48) years with symptomatic uterine fibroids, sometimes with coexisting adenomyosis, and bleeding persistence despite treatment with the LNG-IUS (52 mg) contraceptive for more than 6 months. The intervention included the combined use of LNG-IUS (52 mg) and relugolix CT (relugolix 40 mg + oestradiol 1 mg + norethisterone acetate 0.5 mg daily). All women (100%) reported complete resolution of bleeding and improved quality of life following the initiation of relugolix CT while maintaining LNG-IUS (52 mg) in place as a contraceptive. No adverse events were observed. The mean followup was 11.2 (range 3-24) months, and satisfaction with the combined treatment was reported as 9.4/10. The sequential combination of the contraceptive LNG-IUS (52 mg) and relugolix CT may offer a safe, well tolerated, and effective non-surgical alternative for the management of symptomatic uterine fibroids, particularly in women who do not completely respond to a 6-month treatment with LNG-IUS (52 mg). These findings support further prospective investigation into this dual therapeutic sequential strategy for symptomatic uterine fibroids.

Prevalence of high-risk HPV and cervical dysplasia in IUD users and controls: a cross sectional study

To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. A cross-sectional register-based study including 16,181 women aged 30-49 years participating in the screening programme for cervical cancer in a Swedish County in 2017-2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04-1.41, and aOR 1.41; 95% CI 1.22-1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02-2.06, and aOR 1.56; 95% CI 1.13-2.16, respectively). No significant differences were found in HPV clearance rates. Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

Efficacy and safety of sterilisation procedures to reduce the risk of epithelial ovarian cancer: a systematic review comparing salpingectomy with tubal ligation

The objective of this systematic review is to evaluate current literature comparing salpingectomy for sterilisation with tubal ligation, regarding the effectiveness and safety, and assess the certainty of evidence. PubMed, Cochrane, and Embase databases were searched. Randomised (RCT) and observational studies were included. Articles were quality assessed and data extracted by two independent authors. Certainty of evidence was assessed using GRADE. Of 2020 articles, 17 were included. No study investigated the risk of EOC. No difference in anti-Müllerian hormone was reported in one RCT at caesarean section (CS). Two cohort studies evaluated ovarian function with surrogate measures and found no difference at caesarean section. Complications did not differ but were inconsistently reported. Laparoscopic tubal ligation was 7 min faster (95% CI 3.8-10.5). Operative time at caesarean section was dependent on the use of surgical devices. Certainty of evidence was low or very low for all estimates, indicating knowledge gaps. Reliable safety data on salpingectomy for sterilisation is lacking, and there is no effectiveness data. Presently, women cannot be properly counselled regarding salpingectomy for sterilisation.

Awareness of the non-contraceptive benefits of reversible contraceptive methods in a cohort of Brazilian women: an exploratory study

We assess the awareness of Brazilian women about non-contraceptive benefits of contraceptives and compare non-health with health care providers. We conducted a survey in Brazil using a questionnaire administered via Google Forms asking women to respond about the awareness of non-contraceptive benefits of combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS), etonogestrel (ENG)-implant, copper intrauterine device (Cu-IUD), and male condom. We received 2,068 completed questionnaires, 720 women (34.8%) aged ≤ 29 years and 236 (11.4%) were physicians or nurses. Only one third of the respondents were aware that COC use is associated with decreased risks of ovarian and endometrial cancers; 296 (16.1%) about that the use of DMPA is associated with a decreased risk of endometrial cancer, and 253 (13.8%) were aware about that the users of the Cu-IUD present lower risk of cervical cancer. We identified significant differences between non-health care providers when compared to physicians or nurses. We found low awareness regarding the associated lower risk of ovarian, endometrial and cervical cancer associated with the use of some contraceptives, evidencing the need to provide more information about the non-contraceptive benefits during training for health care providers.

The use of hormonal contraceptives in a cohort of healthy women with BRCA mutations under surveillance in an Italian Family Cancer Clinic

From hesitancy to hope: charting India’s path to widespread HPV immunisation

Cervical cancer remains the leading gynaecological malignancy in India, with a disproportionate burden among underserved populations. Although HPV vaccines have been available since 2008, national coverage has been hindered by safety concerns, misinformation, sociocultural resistance, and logistical barriers. The introduction of To achieve the WHO's cervical cancer elimination targets, India must pursue a dual approach: gender-neutral HPV vaccination alongside accessible, structured cervical screening programmes. A coordinated, evidence-based strategy is essential for equitable and sustained public health impact.

Post-reproductive aged women: a lost generation in the cervical cancer screening programme

The aims of the study were to find out why some post-reproductive aged women did not participate in the organised cervical cancer screening programme in Latvia and to clarify factors that would motivate them to take part. A cross-sectional study was carried out between January and July 2017 among female patients in three general practitioner (GP) practices. GP practice nurses used the Latvian national health service database to identify women aged 25-70 who had not participated in the organised programme for the last 3 years. Participants were asked to complete a specially developed questionnaire. The results were then compared between three age groups: 25-34, 35-49 and 50-70 years. Included in the study were 523 out of 992 women who had not attended screening; 41% were in the age group 50-70 years. Post-reproductive aged women statistically significantly more often did not take part in the programme because of lack of time (26.4%), too great a distance to the gynaecology screening clinic (10.4%), lengthy appointment waiting time (8.5%) and a belief that a smear test was unnecessary for them (8.5%); 32.1% of women in this age group indicated that if the cervical screen could be carried out by their GP it would facilitate their participation in the programme. Post-reproductive aged women in Latvia often do not attend cervical cancer screening. Analysis of personal and organisational barriers confirmed that the involvement of GPs would encourage older women to participate in the organised screening programme.

Is women’s sexual function impaired by an abnormal pap smear?

Although the stressful psychological impact on women of an abnormal Pap smear is well documented, little research has been undertaken on its sexual impact. Our objective was to assess the impact of an abnormal Pap smear on the sexual function of affected women. A prospective study compared the sexual function of 48 women with an abnormal Pap smear (case group) with that of 48 women with a normal Pap smear (control group). Sexual function was assessed using the Female Sexual Function Index and the Hospital Anxiety Depression Scale. The questionnaires were mailed to the participants. Surprisingly, the risk of sexual dysfunction was comparable between women with and without an abnormal Pap smear (odds ratio [OR] 0.7; Contrary to our clinical experience, female sexual function is not impaired by an abnormal Pap smear. Further research is needed to better understand how sexuality in women with abnormal Pap smears may be affected.

Intrauterine devices and gynaecological malignancies - an umbrella review of systematic reviews and meta-analyses

The intrauterine device (IUD) is globally recognised as a safe, cost-effective, and reliable contraceptive. This umbrella review and meta-analysis synthesises current evidence regarding the association between IUD usage and incidence of gynaecological and breast malignancies. A comprehensive search of PubMed, Cochrane Library, and Ovid databases was conducted for systematic reviews and meta-analyses examining any type of IUD in relation to gynaecological and breast cancers. The screening and data extraction processes adhered to PRISMA guidelines, and random-effects meta-analysis was employed for data synthesis. 323 titles and abstracts were screened, leading to the review of 41 full texts and the inclusion of 17 articles. Analyses of these articles and of their 32 primary sources indicated a decreased risk of cervical, endometrial and ovarian cancer for ever-users of IUD (respective OR: 0.63 [95% CI 0.48-0.82], 0.41 [0.31-0.54], and 0.71 [0.59-0.86]; all IUD use is associated with a reduced risk of ovarian, endometrial, and cervical cancers, while no link was found with breast cancer. These findings can inform patient counselling on the benefits and risks of IUD use.