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Women With CF Use Combined Hormonal Contraceptives More Than Other Methods, Study Reports

Among women of childbearing age with cystic fibrosis (CF), the use of combined hormonal contraceptives containing both estrogen and progestin is more common than condoms or other methods of contraception, according to data from a pilot registry study.

The study, which linked survey findings to patient data from the Cystic Fibrosis Foundation National Patient Registry (CFFNPR), also revealed that pregnancies were unplanned for half of the women who reported becoming pregnant over the study time period.

CF is associated with increased health risks during pregnancy, and for this reason, clinicians typically take a cautious approach when it comes to pregnancy. Yet, data from a study published in 2016 revealed that only about half of women of reproductive age with CF use contraceptives.

Additionally, recent studies suggested that some medications normally prescribed to treat CF, such as the CFTR modulator lumacaftor (available in combination with ivacaftor under the brand name Orkambi by Vertex), may interact with certain hormonal contraceptives. This, in turn, may place women at an increased risk for other health complications and unintended pregnancy.

Investigators at the University of Washington School of Medicine, along with other colleagues in the U.S., carried out a pilot study to assess the use of contraceptives and pregnancy intention in a group of women of childbearing age with CF.

They also investigated possible associations between certain types of hormonal contraceptives and health complications in women with CF.

During the study, 150 women with CF, ages 18–49, who were registered on the CFFNPR, were asked to complete an online survey containing a series of questions about pregnancy and contraceptive use.

Researchers then merged data obtained from surveys with clinical information from the patient registry and used statistical analyses to look for possible relationships between the use of certain methods of contraception and adverse health outcomes.

Study findings showed that oral combined contraceptives containing both estrogen and progestin were the most common form of contraception used by women with CF (42%). This was followed by barrier methods such as condoms (34%) and long-acting reversible contraceptives methods (27%), such as intrauterine devices (IUDs) and implants.

Interestingly, the use of long-acting reversible contraceptives was more than two times higher in CF patients than in women in the general population (11%), which researchers attribute to the necessary contraceptive requirements for patients enrolling in clinical trials “due to the unknown effects of trial medications on fetal outcomes.”

Additionally, findings revealed that among the 50 women (33%) who reported a pregnancy during the study time period, half had had an unplanned pregnancy. Of these, half reported using condoms or combined hormonal contraceptives during the year in which they got pregnant.

“While the absolute number of women reporting prior pregnancies was small, the surprising proportion of unplanned pregnancies in this population raises the need to validate this finding with larger studies,” the researchers wrote.

Although not statistically significant, the use of combined hormonal contraceptives showed a trend toward a greater likelihood of infections caused by mucoid strains of Pseudomonas aeruginosa than with no contraceptive use. The chances of similar infections, as well as worse lung function, and of having at least two pulmonary exacerbations were also increased by progestin-only contraceptive methods, though also not significantly.

Those using non-hormonal methods, on the other hand, showed a trend toward better pulmonary outcomes in terms of infections, exacerbations, and lung function.

The investigators also found that women with CF using depot medroxyprogesterone acetate (sold under the brand name Depo-Provera) as a form of contraception were significantly more likely to develop osteoporosis, a medical condition in which bones become weaker and more prone to fractures, than those who did not use this method.

“While no definite conclusions can be made regarding hormonal contraceptive use on pulmonary or bone health among women with CF, our preliminary findings suggest a larger trial that adequately assesses risk while accounting for potential confounders is essential,” the investigators wrote.

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