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Objective: To compare cycle outcomes after scheduling with the standard long protocol versus the use of oral contraceptive pills (OCPs) in patients undergoing GnRH antagonist cycles. Design: Prospective, randomized, controlled trial. Setting: University-affiliated private assisted reproduction center. Patient(s): Regularly cycling women aged ≤38 years with fewer than three previous IVF attempts were enrolled. Previous low responses to controlled ovarian hyperstimulation, ovarian surgery, or polycystic ovary were exclusion criteria. Intervention(s): One hundred fifteen patients received OCP (0.030 ethinyl E2/0.15 desogestrel) for 12–16 days, and controlled ovarian hyperstimulation was started on day 5 after OCP treatment; similarly, 113 patients received the long protocol from day 20–22 of the previous cycle. Main Outcome Measure(s): The primary outcome was ongoing pregnancy rate; secondary outcome variables were clinical pregnancy rate, live birth rate, implantation rate, and miscarriage rate. Result(s): Patients receiving the GnRH antagonist treatment showed a lower peak serum E2 (1,334 vs. 1,823 pg/mL) but similar peak serum PE (0.58 vs. 0.65 ng/mL), lower duration of the stimulation (10.3 vs. 11.4 days) with similar FSH consumption (1,613 vs. 1,807 IU), and ovarian response (10.2 vs. 11.7 oocytes). No differences were observed in the fertilization rates (68.1% vs. 64.8%), total number of embryos obtained (5.9 vs. 6.2), mean number of embryos transferred (1.8 vs. 1.8), implantation rate (36% vs. 39%), miscarriage rate (8.9% vs. 17%), ongoing pregnancy rate (47.8% vs. 53.9%), or live birth rate (44.3% vs. 47%). Conclusion(s): Comparable outcomes can be obtained using OCP containing 0.030 ethinyl E2/0.15 desogestrel to schedule patients undergoing the antagonist protocol. [Copyright &y& Elsevier]

Abstract: Chronic pelvic pain (CPP) is a common debilitating condition affecting 4–25% of women in the reproductive age group. Endometriosis is the commonest cause. Other gynaecological and non-gynaecological causes include adenomyosis, pelvic inflammatory disease, uterine fibroids, irritable bowel syndrome and interstitial cystitis. Other causes can be musculoskeletal, neurological or psychological. Investigations are of limited value in the diagnosis of CPP. Laparoscopy remains the gold standard in diagnosis. This article explores the various medical and surgical management options of CPP based on recent evidence available. A multidisciplinary approach should be undertaken in women with more severe problems. First line medical management options include nonsteroidal anti-inflammatory drugs, oral contraceptive pills and progestogens. Other medications like androgenic agents and gonadotropin-releasing hormone (GnRH) analogues have been used with various side effect profiles. For those patients who need to be treated surgically, a maximum effort must be made to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibres and treat surgically accessible disease. [Copyright &y& Elsevier]

In 2011, there are greater than 20 antiepileptic medications available. These medications work by modulating neuronal excitability. Reproductive hormones have been found to have a role in the pathogenesis and treatment of seizures by also altering neuronal excitability, especially in women with catamenial epilepsy. The female reproductive hormones have in general opposing effects on neuronal excitability; estrogens generally impart a proconvulsant neurophysiologic tone, whereas the progestogens have anticonvulsant effects. It follows then that fluctuations in the levels of serum progesterone and estrogen throughout a normal reproductive cycle bring about an increased or decreased risk of seizure occurrence based upon the serum estradiol/progesterone ratio. Therefore, using progesterone, its metabolite allopregnanolone, or other hormonal therapies have been explored in the treatment of patients with epilepsy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epigenetic changes, geography and environmental factors do surpass the genetic factors in the development of breast cancer. This study investigates the association of reproductive factors with the breast cancer in this context. OBJECTIVE: To detect the association of reproductive risk factors with breast cancer in an urban set up at central India. STUDY DESIGN: Matched paired community-based case-control study. MATERIALS AND METHODS: The study was conducted for a period of a year from October 2008 to August 2009 in Bhopal (MP). Demographic data and reproductive risk factor related information were collected using structured questionnaire. Data analysis was done by Epi-info and SPSS 16. RESULTS: History of using oral contraceptive pills (OR = 3.02, 95% CI: 1.28-7.11), history of not having breastfeeding (OR = 3.62, 95% CI: 1.29-10.16) and family history of breast cancer (OR = 3.98, 95%CI: 1.06-14.826) were associated significantly with the occurrence of breast cancer in multivariate analysis. CONCLUSIONS: The findings of the present study suggests that positive family history of breast cancer and history of using OCP may be the epigenetic factors promoting the occurrence of breast cancer while breastfeeding reduces the possibility of acquiring breast cancer. [ABSTRACT FROM AUTHOR]

Abstract: Background: Little is known about the out-of-pocket expenditures and dispensing patterns for oral contraceptive pills (OCPs), factors associated with these outcomes and whether they change over time. Study Design: Observational cohort using 1996–2006 Medical Expenditure Panel Surveys. Results: Women spent $16 out-of-pocket per pack, on average (median=$10.41). Of the OCP users, 38% paid $15 or more per pack and 44% obtained one pack per purchase. Over time, fewer women paid $15 or more (52% in 1996–1998 vs. 34% in 1999–2006, p<.001) and fewer obtained one pack per purchase (76% in 1996–1998 vs. 35% in 1999–2006, p<.001). Age and insurance were associated with out-of-pocket expenditures and dispensing patterns. Conclusion: Women paid a substantial amount out-of-pocket for OCPs and dispensing limits remained, although these improved over time. Better insurance coverage of contraception and policies targeting younger women and the uninsured in particular would help overcome barriers to OCP access. [Copyright &y& Elsevier]

Abstract: Background: Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa. Methods: We assessed the trends in HC use among HIV-infected women in Rakai, Uganda; determined factors associated with HC use and considered whether those factors changed over time. Results: HC use among HIV-infected women in Rakai increased from 5.7% in 1994 to 19.2% in 2006, but nearly half of all pregnancies in this population were unintended. Variables associated with increased HC use included higher education, socioeconomic status, parity, sexual frequency, being currently married or in a relationship, discussion of family planning with a partner and receipt of HIV results. Variables negatively associated with HC use included symptoms suggestive of opportunistic infections, having no sex partner in the past year, condom use, breastfeeding and older age. Most associations remained stable over time. Conclusion: Although contraceptive use by HIV-infected women has increased three-fold in this rural population, unintended pregnancies persist, placing women and their children at risk of adverse consequences. [Copyright &y& Elsevier]

Abstract: Background: Experimental evidences suggest that metabolic activation and conversion of oral contraceptive pills (OCPs) to reactive species are responsible for their genotoxicity. The present study was undertaken to investigate the effects of low-dose (LD) OCPs on the activities of erythrocyte antioxidant enzymes glutathione peroxidase (GPx) and superoxide dismutase (SOD) in OCP consumers. Study Design: Enzyme activities were assayed spectrophotometrically in 50 healthy women with normal menstrual cycles who served as the control group and 50 women taking LD OCPs. Results: The pooled data obtained for erythrocyte GPX activity in OCP consumers (50.05±14.9 U/g of Hb) was significantly higher (+15.4%, p=.015) than in the control group (42.33±16.31 U/g of Hb), but the same comparison for SOD activity between the control group (83.46±23.97 U/g of Hb) and women receiving OCPs (81.83±23.97 U/g of Hb) showed an insignificant (−2%, p=.699) decrease. The duration of intake of OCPs beyond 36 months had an effect on the magnitude of the increase (+16.2%) and the decrease (−11%) in GPx and SOD activities, respectively. There was a significant and considerable (not significant) correlation between the activities of GPx (p=.039) and SOD (p=.102) with the duration of OCP consumption, respectively. Conclusion: These findings suggested that OCPs may stimulate or reduce the activities of GPx and SOD enzymes, respectively. This may be due to an effect of these pills on bone marrow erythroblast maturation via stimulation or inhibition of the synthesis of new active GPx and SOD molecules or may be a result of the increased frequency of an allele of the GPx and SOD enzymes. It is suggested that these alterations in GPx and SOD activities may be related to their probable protective effects in response to various pathological and physiological properties of OCPs. It seems that probably free radicals produced during metabolism of OCPs provoke the activity of antioxidant enzymes. [Copyright &y& Elsevier]

Abstract: Background: This study compared the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) to low dose combined oral contraceptive pills (COC) in the management of idiopathic menorrhagia. Study Design: A single-center, open, randomized clinical trial. One hundred twelve women complaining of excessive menstruation who desired contraception were randomized to receive LNG-IUS or COC. Treatment failure was defined as the need for medical or surgical treatment during the follow-up. Other outcomes included: menstrual blood loss (MBL) by alkaline hematin and by pictorial blood assessment chart (PBLAC), hemoglobin levels and assessment of lost days in which physical or mental health prevented participating women from performing usual activities. Results: At baseline, LNG-IUS (n=56) and COC (n=56) groups were comparable in age (mean±S.D.) (39.3±6.7 vs. 38.7±5.2 years, p=.637), parity (median and range) [3(1-6.4) vs.3(2-6), p=.802] and BMI (mean±S.D.) (29.6±5.9 vs. 31.1±5.7 kg/m2, p=.175). Time to treatment failure was longer in LNG compared to COC group with a total of 6 (11%) patients who had treatment failure in the LNG-IUS compared to 18 (32%) in COC group with a hazard ratio of 0.30 (95% CI, 0.15-0.73, p=.007). Using alkaline hematin, the reduction in MBL (mean±S.D.) was significantly more in the LNG-IUS group (87.4±11.3%) compared to the COC group (34.9±76.9%) (p=.013). Utilizing PBLAC scores, the reduction in the LNG-IUS (86.6±17.0%) group was significantly more compared to the COC group (2.5±93.2%) (p<.001). In the LNG-IUS group, increase in the hemoglobin and ferritin levels (mean±S.D.) were noted (from 10.2±1.3 to 11.4±1.0 g/dL; p<.001; with reduction of the number of lost days (from 6.8±2.6 to 1.6±2.4 days, p=.003). Conclusion: The LNG-IUS is a more effective therapy for idiopathic menorrhagia compared to COC. [ABSTRACT FROM AUTHOR]

Background: Combined oral contraceptive pills were the first contraceptive method to provide sexual freedom of choice for women through reliable, personal and private control of fertility. They are the most widely used hormonal contraceptives and also the most popular non-surgical method of contraception. Objective: To review the profile of acceptors of combined oral contraceptive pills at the University of Uyo Teaching Hospital, Uyo. Methodology: An 8 year review of all clients that accepted combined oral contraceptive pills in the family planning clinic. Results: There were 1,146 new contraceptive acceptors during the period of study out of which 309 (27.9%) accepted the pills. Majority of the clients were between 20 and 29 years of age (54.0%), were multiparous (72.8%), Christians (99.7%) and 61.2% had tertiary level education. Two hundred and fifty-five women (82.5%) desired to use combined oral contraceptive pills to space births while 7.8% wanted to limit child bearing. There was a high discontinuation rate among the women (45.0%) and out of these 87.9% of the clients changed to other contraceptive methods. All the clients commenced their pills within seven days of menstruation and only the low dose monophasic preparations were available in the family planning unit and thus were given to the clients. Conclusion: Women who accept to initiate combined oral contraceptive pills in our center are young, well educated, multiparous women who want to space their pregnancies. However, due to the high discontinuation rate among the clients, there is need for further studies evaluating reasons for the high discontinuation rate, exploring interactions between clients and providers' and also providers' attitude towards combined pills in our environment. [ABSTRACT FROM AUTHOR]

A femoral vein thrombosis, originally diagnosed with conventional ultrasound, was fully elucidated and monitored utilizing serial high-resolution magnetic resonance venography in a 19-year-old female with a family history of venous thromboembolism. Genetic testing revealed she was heterozygous for a F5 gene mutation, an abnormality that predisposes carriers to factor V Leiden thrombophilia. An additional risk factor included use of oral contraceptive pills. Subsequent testing of her family uncovered other carriers of the mutation, allowing for the implementation of preventive measures for the entire family. Although magnetic resonance venography has not yet proven to be a cost-effective method for monitoring clot resolution, the case presented here encourages further research on the clinical utility and cost-benefit of utilizing this technology for monitoring venous thrombosis and for clinical management purposes. [ABSTRACT FROM AUTHOR]

Objective: To know the awareness of emergency contraception (EC) among our population. Patients and Methods: Women were asked about their age, education, socioeconomic condition and parity. Results: Total 400 women were interviewed in the cross - sectional survey. Out of these, only 193 had heard about EC and they were further asked about knowledge relating to EC utilization. 132 (68.39%) answered incorrectly about emergency contraception. While only 31 (16%) women had knowledge of its correct utilization. Only 19 (9.84%) women knew that OCPS can be used as EC while 151 (78.23%) answered incorrectly that it can be used on regular basis. Out of 193 women, 53 (27.46%) women practiced EC while 140 (72.53%) had never used EC. Conclusion: Our study showed limited knowledge of women concerning EC. Media should be used to disseminate the awareness of women about safety, use and effectiveness of EC. Also it is responsibility of health care providers that they should give information of EC to every sexually active woman visiting their clinics. [ABSTRACT FROM AUTHOR]

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disorder affecting women and has reproductive, metabolic, cardiovascular health implication across the life span. Insulin resistance in PCOS has been considered main etiological factor for major health related consequences. In order to control the vicious cycle of this syndrome and better understanding of pathogenesis, an outburst of research has occurred in this field. More research in genetics and environmental factors are needed to underscore preventive strategies. [Copyright &y& Elsevier]

Abstract: Background: The study was conducted to evaluate follicular development and hormone patterns with three oral contraceptive (OC) regimens before, during and after the 7-day hormone-free interval (HFI) or 7-day ethinyl estradiol (EE)-supplemented interval. Study Design: The study is a single-center, open-label, prospective, randomized trial to evaluate pituitary–ovarian suppression with three OC regimens containing identical hormones: 30 mcg of EE and 150 mcg of levonorgestrel (LNG). Methods: After a standard 21/7 OC baseline cycle, subjects were randomized to one of three treatment groups: (1) three 21/7-day cycles of 150 mcg LNG/30 mcg EE for 21 days followed by 7 days of placebo (n=10); (2) one 84/7-day cycle of 150 mcg LNG/30 mcg EE for 84 days followed by 7 days of placebo (n=12) and (3) one 84/7EE-day cycle of 150 mcg LNG/30 mcg EE for 84 days followed by 7 days of 10 mcg EE (n=11). Estradiol; follicle-stimulating hormone (FSH); luteinizing hormone and inhibin-B levels, ovarian follicles and daily symptom diaries were collected. Results: Compared to subjects receiving placebo during the 7-day HFI, those receiving EE demonstrated reductions (p<.05) in both FSH and estradiol. Number of developing follicles was less after the 7-day EE interval compared to that after 7-day HFI. Subjects on the 84/7 and 84/7EE regimens reported less (p=.03) daily menstrual flow than those on the 21/7-day regimen. A trend (p=.06) toward reduced headaches during the 7-day EE-supplemented interval was noted. Conclusions: Supplementation of the standard 7-day HFI with 10 mcg EE after 84 days of an extended OC decreased FSH levels and decreased the number of developing follicles. [Copyright &y& Elsevier]

Objective To evaluate the effect of oral contraceptive pills (OCP) pretreatment on IVF cycle outcome in GnRH-antagonist protocol. Design Retrospective cohort study. Setting Major tertiary university-affiliated center. Patients All patients treated with GnRH antagonist in our IVF unit during the last 3 years were included in the study. Overall 1,799 IVF cycles were performed. Of these, in 604 cycles OCP pretreatment was used prior to GnRH-antagonist for cycle scheduling. Patients were divided into two age groups--young group aged ≤35 years and older group aged ≥36 years. Interventions The young group underwent 927 cycles, 281 cycles with OCP pretreatment and 646 cycles without. The older group underwent 872 cycles, 323 cycles with OCP pretreatment and 549 cycles without. Data was analyzed within each age group. Main outcome measures Treatment duration and total dose of FSH IU used for stimulation, number of oocytes retrieved, implantation and pregnancy rates. Results All OCP-pretreated cycles required significantly longer stimulation than non-pretreated cycles (young: 10.76 vs. 9.21 days; older: 10.48 vs. 8.73 days, respectively) and higher total dose of FSH IU (young: 3,210 IU vs. 2,565 IU; older: 4,973 IU vs. 3,983 IU, respectively). There were no other differences in cycle characteristics between groups. Implantation and pregnancy rates were not affected by OCP pretreatment. Conclusions OCP pretreatment can be offered as a mode for cycle scheduling prior to GnRH-antagonist protocol, though it may be associated with longer stimulation and higher gonadotropin consumption. [ABSTRACT FROM AUTHOR]

Introduction. Vulvar vestibulitis syndrome (VVS) is a diverse, multifactorial phenomenon. Its precise etiology is unknown. Aim. To define the association between oral contraceptive (OC) estrogen dosage and VVS. Methods. Women diagnosed as having VVS participated in the study. Main Outcome Measures. Data on type and usage of oral contraceptive pills (OC) were obtained by a questionnaire, and they were compared for the data on OC usage in the general population. Results. Available commercial data on Israeli women taking OC showed that 51% of them use low-dose estrogen (≤20 µg) OC and 49% use higher-dose estrogen (30–35 µg) OC. Of the 132 women in the study, 86 (65%) used OC: 68 (79%) used low-dose estrogen OC ( P < 0.002 compared to the general population), while only 18 (21%) used high-dose estrogen OC ( P < 0.002 compared to the general population). Conclusion. Significantly more patients who are treated in our clinic for VVS use low-dose estrogen than those who use high-dose estrogen OC. Greenstein A, Ben-Aroya Z, Fass O, Militscher I, Roslik Y, Chen J, and Abramov L. Vulvar vestibulitis syndrome and estrogen dose of oral contraceptive pills. J Sex Med 2007;4:1679–1683. [ABSTRACT FROM AUTHOR]

Objective: The use of oral contraceptive (OC) pills alters the characteristic features of polycystic ovary syndrome (PCOS) complicating the diagnosis of this disease. Anti-Müllerian hormone (AMH) levels are high in PCOS patients and are stable throughout the menstrual cycle in healthy subjects. This study examined the influence of hormonal suppression with OC therapy on the serum AMH levels in women with PCOS and with normal menstrual cycles. Study Design: Thirty women with PCOS and 15 women with normal menstrual cycles were enrolled in this prospective study. Serum was collected from the subjects during the early follicular phase of the menstrual cycle and after the sixth cycle of oral contraceptive therapy, and stored frozen until assayed. The effect of OC therapy on the serum AMH, estradiol (E(2)), luteinizing hormone (LH), follicle-stimulating hormone (FSH), free testosterone, total testosterone, and dehydroepiandrosterone sulfate (DHEA-S) levels was studied. In addition, ovarian volume and follicle count were assessed. Results: The serum AMH levels in PCOS patients were significantly higher than in healthy women at baseline (+/-S.D.; 5.49+/-2.26 and 1.93+/-0.51 ng/ml, respectively; p=0.001). After six cycles of OC therapy, no significant changes in the AMH levels were observed in either the PCOS patients or normally cycling women. Ultrasound showed significant reductions in ovarian volume and follicle number and size at 6 months in both groups. Conclusion: Although significant reductions were observed in ovarian volume and follicle number, 6 months of contraceptive therapy did not change the serum AMH concentration in either group. AMH may be considered a new marker in PCOS patients who are already on contraceptive treatment. [ABSTRACT FROM AUTHOR]

Objective: To compare FSH, LH, estrogen, and P flare response following 1 mg lupron injection in poor responders with or without pretreatment with oral contraceptive pills (OCPs). Design: Prospective study. Setting: University hospital. Patient(s): Poor responders undergoing IVF flare protocol from October 2002 to November 2003. Intervention(s): Patients were divided into group A, who received OCPs before IVF cycle (n = 12), and group B, who did not (n = 7). One milligram Lupron was injected SC after measuring day 2 serum FSH, LH, estrogen, and P. After 24 hours, serum hormones were measured before lupron administration. Main outcome measure(s): Serum FSH, LH, estrogen, and P before and after 1 mg lupron Result(s): Basal FSH was similar in both groups (8.6 ± 4.5 vs. 9.6 ± 2.9 mIU/mL). Group A patients had significantly lower day 2 FSH (3.6 ± 3.6 vs. 10.1 ± 4.2 mIU/mL; P<.05). After lupron, although both groups had a significant rise in FSH and LH, mean LH rise in group B was 39.5 ± 31 mIU/mL versus 11.3 ± 4.6 mIU/mL in group A (P<.05). Conclusion(s): Pretreatment with OCPs in GnRH agonist flare protocol suppresses pre-Lupron FSH but does not blunt FSH flare. It blunts LH flare, which may be beneficial. [Copyright &y& Elsevier]

Abstract: Objective: The study was conducted to assess hormone withdrawal symptoms, patient acceptance and occurrence and management of bleeding with an extended oral contraceptive (OC) regimen. Methods: Subjects were placed on an OC containing 3 mg drosperinone (DRSP) and 30 μg ethinyl estradiol (EE), in the standard 21/7 fashion for two cycles, before converting to an extended pattern of OC for women who indicated they had menstrually related symptoms such as headaches, cramping and mood swings (52 weeks with phone-call follow-up 6 months later). Daily assessments of bleeding, headache, pelvic pain, mood and number of pain pills were recorded. Results are reported as means with S.E., and values were compared using analysis of variance with Dunnett''s post hoc test for comparison with 21/7 cycle, Duncan''s post hoc test for comparison of changes during the course of the extended regimen and Pearson''s chi-square for comparison of proportions. Results: Of the 111 women who began the extended OC regimen, 80 completed 1 year of use. Mood scores, headache scores and pelvic pain were all improved in the extended OC intervals, compared to the 21/7 cycle (p<.001 for all comparisons). Improvement in symptoms persisted throughout the 1 year extended regimen. The findings indicated that 53.7% of subjects had no breakthrough bleeding or breakthrough spotting (BTB/BTS) during any given 28-day interval of the extended regimen. BTB/BTS decreased in the second half compared to the first half of the extended regimen. To manage BTB/BTS, instituting a 3-day hormone-free interval (HFI) was significantly more effective than continuing OCs (p<.001). At the 6-month follow-up, most subjects had continued the extended regimen on their own with a high level of satisfaction. Conclusions: An extended OC regimen containing DRSP/EE significantly improved mood, headaches and pelvic pain scores throughout the 1 year of use, compared to a 21/7 cycle. Sustained BTB/BTS episodes occurred in 45 subjects (56%), decreasing in the second half of the study and effectively managed with a 3-day HFI. [Copyright &y& Elsevier]

Objective.—The aim was to assess the timing and severity of self-reported headaches in patients utilizing a standard 28-day oral contraceptive (OC) cycle consisting of 21 hormone (estrogen + progestin)-containing pills and 7 placebo pills (ie, 21/7-day cycle) converted to a placebo-free extended OC regimen. Methods.—An open label single-center prospective analysis of headaches recorded daily on a severity scale of 0 to 10, along with the headache item of the Penn Daily Symptom Rating (DSR17) and a weekly modified Migraine Disability Assessment (MIDAS) headache questionnaire, during standard 21/7-day cycles followed by a 168-day extended placebo-free regimen of an OC containing 3 mg of drosperinone and 30 mcg of ethinyl estradiol (DRSP/EE). Results.—Of the 114 patients who began the trial, 111 completed the 21/7-day cycle portion of the study. Based on the headaches scales, there were significant differences in headache severity among the 28 days of the standard 21/7 cycles ( P < .001). Greater headache severity occurred on days 25 through 28 during the 7-day placebo interval of the 21/7 cycles ( P < .05). Of the 111 patients who completed the 21/7 phase of the study, 102 (92%) completed the 168-day extended placebo-free OC regimen. During the first 28 days of the extended placebo-free regimen, daily headache scores decreased ( P < .0001) compared to those of the previous 21 active/7 placebo day cycle. The difference on a daily basis was first detected on extended cycle days 25 through 28 ( P < .0001) and persisted throughout the remainder of the 168-day regimen. Subjects were divided into 2 groups (severe and mild) based on the median of the total headache score during the 21/7 OC cycle. The group with higher total headache scores demonstrated a significant ( P < .0001) reduction in daily headaches beginning in the first 28-day interval of the extended placebo-free regimen, persisting throughout the entire 168-day extended regimen. In contrast, the group with the lower total headache score remained unchanged ( P= .79) throughout the extended regimen. Impact of headaches on work, family, and social functions also improved on the extended placebo-free regimen in 6 of 8 measures ( P < .05) assessed by weekly headache questionnaires. Conclusion.—Compared to a 21/7-day OC regimen, a 168-day extended placebo-free regimen of DRSP/EE led to a decrease in headache severity along with improvement in work productivity and involvement in activities. This is a preliminary study and results may not be widely generalizable. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: The purpose of this study was to analyze the vocal quality and resonance (nasality and nasalance values) during the menstrual cycle in professional voice users using oral contraceptive pills (OCPs). Although professional voice users are more sensitive and aware of their vocal quality, no changes of voice and resonance characteristics were expected because OCPs create a stable hormonal balance throughout the menstrual cycle. Study Design: The authors conducted a comparative study of 24 healthy, young professional voice users using OCPs. One assessment was performed between the 10th and 17th day of pill intake, when hormonal levels reached a steady state. The second assessment was performed during the first 3 days of menses, when no pills were taken and hormonal levels were minimized. Methods: Subjective (perceptual evaluation of voice and nasality) and objective (aerodynamic, voice range, acoustic, Dysphonia Severity Index [DSI], nasometer) assessment techniques were used. Results: The Mann-Whitney U test showed no significant difference between the perceptual evaluation of the voice and the nasality in the two assessments. The paired Student t test showed no significant difference regarding the maximum phonation time, the vocal performance, the acoustic parameters, and the DSI. Conclusions: These findings indicate that OCPs do not have an impact on the objective and subjective voice and resonance parameters in young professional voice users. This information is specifically relevant to professional voice users who are more aware of vocal quality changes and ear, nose and throat specialists/voice therapists who treat professional voice users with voice problems/disorders. Further research regarding the impact of increased vocal load during the premenstrual or menstrual phase in professional voice users using OCPs should be considered. [ABSTRACT FROM AUTHOR]

Abstract: Background: St. John''s wort (SJW), a commonly used herbal remedy, has been shown to compromise the efficacy of drugs, including oral contraceptive pills (OCPs), by inducing cytochrome P-450. We investigated whether the simultaneous use of SJW with OCPs resulted in elevated serum androgen levels with implications of impaired OCP treatment of hirsutism and acne. Materials and Methods: Fifteen healthy women were treated with the low-dose OC Loestrin 1/20™ for 2 months and then additionally with SJW for 2 months. Androgen and sex hormone-binding globulin (SHBG) levels were measured in serum by immunoassay methods; free testosterone (fT) was calculated. Results were analyzed using the Wilcoxon signed-rank test. Results: There were no statistically significant differences in androgen levels after the addition of SJW in women using Loestrin 1/20™. However, there were decreases in total testosterone and fT levels (10.7% and 15.8%, respectively) along with a small increase in SHBG levels (7.0%). Conclusions: In women using OCPs and SJW simultaneously, it appears that SJW does not interfere with the antiandrogenic properties of OCPs. [Copyright &y& Elsevier]

Abstract: Context: Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens'' concerns and misperceptions about the menstrual-related side effects of HC. Methods: Open focus groups were conducted with both sexually active and virgin adolescent women aged 12–18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, “What are the things you have heard about the birth control pill, Depo-Provera and Norplant?” Groups were audio-recorded, transcribed and analyzed using qualitative software. Results: We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: “Spotting,” intermenstrual bleeding and amenorrhea cause doubts about the method''s effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health. Conclusions: Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions. [Copyright &y& Elsevier]

Oral contraceptive pills (OCP) contribute a major share in the current method-mix in Bangladesh. However, multiple studies show high discontinuation rates of OCP. The present study examines the behavior and attitude towards OCP use, and investigates the determinants of its discontinuation among the rural married women of Bangladesh. The present study is based on critical analyses of the data from 24 focus group discussions and 135 in-depth-interviews with women, their husbands and key informants conducted over the period of 1 year. The present study shows that more than two-thirds of married women have at one time or another used OCP as a method of family planning. However, many women did not take the pills regularly and about one-quarter of ever users had taken, at one stage or another, a ‘short break’ from OCP use. Although nearly half of them took a break because of side effects, interestingly, 16% took a break as the result of fear of health problems that were related to ‘folk stories’ and other misconceptions. The individual assessment by users of the national family planning service delivery, perceived side effects, misconceptions about continuous use of pills, quality of counseling and information, and contraceptive behavior of the OCP users considerably influenced the decisions on contraceptive use or non-use. (Reprod Med Biol 2006; 5: 111–121) [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of a low-dose combined oral contraceptive pill (OCP) on peripheral neuroactive steroid concentrations, precursors for neuroactive steroid synthesis, and mood in healthy women desiring contraception. These neuroactive steroids are γ-aminobutyric acid receptor agonists and are important in the modulation of affect and adaptation to stress. Design: Prospective observational study. Setting: Human ambulatory patient study. Patient(s): Healthy OCP-naive women without current or history of affective disorder. Intervention(s): A 0.020-mg ethinyl E2–0.1-mg levonorgestrel containing OCP for 3 months. Main Outcome Measure(s): Serum neuroactive steroids allopregnanolone, allotetrahydrodeoxycorticosterone, and DHEA; neuroactive steroid precursors P and pregnenolone; E2; and mood and anxiety as assessed by the Premenstrual Syndrome Daily Ratings Form, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Profile of Mood States. Result(s): The combined OCP resulted in a decrease in neuroactive steroids and neuroactive steroid precursors as well as in E2. However, this decline was not associated with adverse mood changes on any of the well-validated assessment tools. Conclusion(s): Healthy women without underlying mood or anxiety disorder who were given a low-dose OCP did not experience adverse psychological symptoms despite a significant reduction in neuroactive steroids. [Copyright &y& Elsevier]

Objective: To evaluate in a clinical practice setting the acceptance, continuation and variability of extending the active interval of oral contraceptives (OCs) with introduction of a shortened hormone-free interval (HFI) to manage breakthrough bleeding.Methods: A retrospective review was undertaken of patients seen by one obstetrician/gynecologist and counseled on extending the active interval of OCs with a shortened HFI of 3–4 days to manage bleeding. Electronic medical records were searched for the phrase “extending the number of active pills” for patients counseled between January 1, 2000, and January 31, 2003, with follow-up through January 31, 2004. A structured query of each patient''s initial and follow-up records was performed.Results: The 220 patients counseled on the extended regimen were 14–52 years of age (mean 36.4, SD 9.3 years). At initial counseling before extending, the majority of patients cited more than one reason for using OCs in the standard fashion with 59% using OCs for noncontraceptive reasons. Reasons for extending the active interval of OCs included premenstrual symptoms (45%), dysmenorrhea/pelvic pain (40%), heavy withdrawal bleeding (36%), menstrual associated headaches (35%), convenience (13%), acne associated with menses (10%) and other (15%). Of the 181 patients with follow-up data, 174 (96%) attempted an extended regimen with 121 (67%) continuing to do so at last follow-up. Follow-up intervals ranged from 0.3 to 3.8 years (mean 1.6 years). Using Kaplan–Meier product limit survival analysis, 60% of patients continued using extended patterns of OCs for more than 2 years. For 121 currently extending, the HFI varied from 0 to 7 days with 88% utilizing a 0 to 4 day HFI.Conclusions: Sixty percent of patients offered extending the active interval and shortening the HFI of OCs initiate and continue this pattern for more than 2 years without serious sequelae or pregnancy while individually directing both the number of days of continuous pills and the length of the HFI. [Copyright &y& Elsevier]

: ContextIn Mexico, oral contraceptives (OCs) are available to women over-the-counter in pharmacies. While past research has suggested that nonmedical providers, such as pharmacy workers, are capable of screening women for contraindications to OCs, little is known about their practices.: MethodsAfter selecting a 10% random sample of all pharmacies in Mexico City (n = 108), we surveyed the first available pharmacy worker to learn more about pharmacy workers'' screening practices when selling OCs over-the-counter to women.: ResultsWhile nearly all of the pharmacy workers surveyed had sold OCs without a prescription, only 31% reported asking women any questions before selling pills. Among those who asked questions, the most commonly asked questions were about other medications a woman was taking, about blood pressure and about alcohol intake. Pharmacy workers did not ask these questions consistently to all clients.: ConclusionTraining pharmacy workers might be one strategy to improve screening of women for pill contraindications. However, pharmacy workers may lack the time and motivation to carry out such screening. An alternative strategy might be to better inform women to self-screen for pill contraindications. [Copyright &y& Elsevier]

Study Objective: Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles.Design: Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent.Setting: Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico.Participants: The sample consisted of 43 female adolescents with a mean age of 17 years.Results: The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC.Conclusions: Health care providers can assess adolescents'' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use. [Copyright &y& Elsevier]

Background: Recent reports of rickets among African American children drew attention to the vitamin D status of these infants and their mothers. African American women are at higher risk of vitamin D deficiency than are white women, but few studies have examined determinants of hypovitaminosis D in this population. Objective: We examined the prevalence and determinants of hypovitaminosis D among African American and white women of reproductive age. Design: We examined 1546 African American women and 1426 white women aged 15-49 y who were not pregnant and who participated in the third National Health and Nutrition Examination Survey (1988-1994). Hypovitaminosis D was defined as a serum 25-hydroxyvitamin D concentration ⩽37.5 nmol/L. Multiple logistic regression was used to examine the independent association of dietary, demographic, and behavioral determinants of hypovitaminosis D. Results: The prevalence of hypovitaminosis D was 42.4 ± 3.1% (x - ± SE) among African Americans and 4.2 ± 0.7% among whites. Among African Americans, hypovitaminosis D was independently associated with consumption of milk or breakfast cereal < 3 times/wk, no use of vitamin D supplements, season, urban residence, low body mass index, and no use of oral contraceptives. Even among 243 African Americans who consumed the adequate intake of vitamin D from supplements (200 IU/d), 28.2 ± 2.7% had hypovitaminosis D. Conclusions: The high prevalence of hypovitaminosis D among African American women warrants further examination of vitamin D recommendations for these women. The determinants of hypovitaminosis D among women should be considered when these women are advised on dietary intake and supplement use. [ABSTRACT FROM AUTHOR]

To describe attitudes and experiences with a low-dose oral contraceptive pill (Alesse) over 3 months, women aged 18 years and older (n = 218) were enrolled from 16 locations to evaluate their experiences with Alesse. The questionnaire assessed demographic and personal characteristics, attitudes and experiences, and satisfaction. The participants had a mean age of 26.7 years and most were single, Caucasian, had completed high school, had a regular sexual partner, and had previously used OCs. Sixty percent of participants could discuss pill use easily with their mothers, 92% with friends, and 96% with partners; 45% of the women were unsure about their mother’s previous OC use. Of the 11 side effects assessed, the most frequently anticipated side effect was weight gain. There was a significant relationship between anticipated and reported side effects for weight and mood changes; however, there remained a number of women for whom these differed. Most (90%) were satisfied with Alesse. Even when beginning on 20 μg pills, some women may still anticipate side effects such as weight gain typically associated with higher doses of estrogen. Healthcare providers should assess women’s attitudes and anticipated experiences with OCs and counsel accordingly. [Copyright &y& Elsevier]

Background. Recent studies have indicated that the risk of thromboembolic disease (VTE) in users of combined oral contraceptive pills (COCs) varies not only with estrogen dose, but also with the progestogen in pills with the same estrogen dose. The aim of this article is to discuss sex hormone binding globulin (SHBG) as a marker of estrogenicity and as a surrogate indicator for the potential risk of VTE in users of COC. Material and methods. Using data from the literature, we investigated the relationship between the risk of VTE with various COCs and their effects on SHBG. We also collected data on the effects on SHBG by some combined preparations, where there are no VTE data. Results. There appears to be a relationship between the risk of VTE and the effect on SHBG. Monophasic preparations containing levonorgestrel, having the lowest risk of VTE, cause an average SHBG increase of around 50%. COCs containing desogestrel or gestodene cause an average SHBG increase of 200–300%. A preparation with cyproterone acetate, carrying a higher risk of VTE than desogestrel and gestodene, cause a 300–400% SHBG increase. With the recently developed combined preparations, there is a 150% SHBG increase with norgestimate and a 250–300% increase with drosperinone and dienogest. Conclusions. We propose that the change in SHBG with a COC could be interpreted as a measure of total estrogenicity and used as a predictor of the risk of VTE. Preparations containing drosperinone, dienogest, cyproterone acetate and norgestimate are equally or more estrogenic than the more thoroughly studied COCs, containing desogestrel or gestodene and should not be considered a safer substitute. [ABSTRACT FROM AUTHOR]

Background: Management of hepatocellular adenoma (HA) is marked by a paucity of recent studies. Long-term follow-up data from an equal access health care system may facilitate our understanding of the natural disease course of HA and identify modifiable risk factors., Methods: A multi-institutional, retrospective review of patients with HA from 2008-2017 was performed. Patient demographics, disease characteristics, and clinical outcomes were analyzed., Results: Of 124 patients identified, 94% were women with a mean age at diagnosis of 39.5 years (range 20-82). Median follow-up was 22.5 months (range 0-114) with thirty-four (27.4%) patients eventually undergoing hepatectomy. Mean BMI of the study population was 30.5 kg/m 2 (range 16-72). Stratified by size, average BMI for adenomas ≥5 cm was 34 kg/m 2 compared to 28 kg/m 2 for those <5 cm ( P < .05). The predominant symptom at presentation was abdominal pain (41.1%), while just 4% presented with acute rupture. Overall incidence of the malignancy was 2.5%. Among all patients, oral contraceptive use was documented in 74 (59.7%) patients, of whom 36 (29.0%) discontinued OC for at least six months. Regression after OC cessation occurred in seven patients (19.4%) while the majority (77.8%) remained stable., Discussion: This decade-long review analyzing the impact of modifiable risk factors identifies a direct correlation between BMI and hepatocellular adenoma size. Rupture and malignant transformation are rare entities. Cessation of OC appears to be an effective strategy in the management of hepatic adenoma. Further investigations are warranted to determine if addressing modifiable risk factors such as BMI might induce further HA regression.

Some research suggests that oral contraceptive pills (OCPs) blunt the cortisol stress response, thus OCP users are often excluded from stress research. The current study examined changes in salivary cortisol among females taking OCPs and naturally cycling (NC) females after exposure to the Trier Social Stress Test (TSST). The literature search included the terms "oral contraceptives" OR "oral contraception" OR "birth control" OR "birth control pill" AND "Trier Social Stress Test" OR "TSST" AND "cortisol" OR "salivary cortisol." A total of 14 studies with 36 independent samples were included in the meta-analysis. Participant information, including pre- and post- TSST measures of salivary cortisol, and subgroup (i.e., OCP or menstrual cycle phase), were extracted. Additional study characteristics including age, length of stressor, type of OCP, time of day the cortisol samples were collected, and type of cortisol assay used were also considered. Findings from the current meta-analysis indicated that changes in salivary cortisol in NC participants following the TSST, D = 4.31, SE = 0.53, 95% CI = 3.27, 5.35, were greater than the changes observed in participants on OCPs D = 1.50, SE = 0.30, 95% CI = 0.91, 2.09. Study effects were heterogeneous, Fisher's Z = 10.87, Q = 620.57, p = < 0.001. Between-phase analyses were also conducted. Results demonstrate that OCPs blunt cortisol reactivity relative to NC females. There was significant heterogeneity, except between OCP and follicular phase groups. Implications for research design and methodology are discussed. • Cortisol response is blunted in OCP users relative to naturally cycling females. • Cortisol response is blunted in OCP relative to luteal phase. • No difference in cortisol responsivity between OCP and follicular phase. • Exclusion of OCP users from laboratory stress research may not be warranted. [ABSTRACT FROM AUTHOR]

Second to the cardiovascular disease, cancer is the main cause of death in Iran. In this study some of the risk factors of breast cancer; especially the ones related to breastfeeding have been assessed. The study was a retrospective study of 100 women with breast cancer. The most important risk factors in breast cancer were number of children, age of mother on the first pregnancy. The result showed that the increase of breast cancer was related to women who stopped breastfeeding before age 24 months. Breastfeeding for more than 12 months will reduce the incidence of breast cancer by 25%. In general there was a reverse relationship between duration of breastfeeding and risk of cancer in premonopausal, but not in postmenopausal women.

Background: To estimate the pooled odds of oral contraceptive pills consumption (OCPs) use as well as pregnancy history and multiple sclerosis (MS) risk., Methods: We systematically searched PubMed, Embase, Scopus, Web of Science, Google scholar, and gray literature including references of the references as well as conference papers. The search strategy in PubMed was ((Oral contraceptive pills) OR OCP) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating) AND (gravidity) OR (pregnancy)., Results: Four studies were included. The pooled odds of developing MS in women with pregnancy history compared with nulligravid women was 0.64 (95%CI = 0.53 - 0.78) ( I 2 = 0, P = 0.5), which means that pregnancy reduces the risk of MS by 36%. The pooled odds of OCP consumption and risk of MS were 1.09 (95% CI = 0.67 - 1.76). By comparing the pooled odds of OCP consumption and risk of MS according to the country of the origin, we found that the pooled odds in Iranian studies was 1.03 (95% CI = 0.31 - 3.45) and the pooled OR in studies that were conducted in the United States was 1.13 (95% CI = 0.65 - 1.98), which showed that the country of the origin was not the cause of heterogeneity., Conclusions: The results of this systematic review show that pregnancy history is a protective factor for MS development, whereas OCP use has no significant effect., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Aim: This meta-analysis was conducted to compare the effect and safety of oral contraceptive pills (OCP) plus orlistat with OCP alone in clinical, hormonal, and lipid metabolism outcomes in patients with polycystic ovary syndrome (PCOS) and overweight/obesity., Methods: Pubmed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and SinoMed were systematically reviewed. A random-effects or fixed-effects model was used to pool the estimate., Results: Eight studies were included in this meta-analysis. Significant reductions in BMI, WHR, and waist circumference were observed in combination group as compared with OCP alone group. Regarding the hormonal outcome, T, SHBG, FAI, LH, DHEAS, FSH, and E2 levels were significantly improved in combination group compared with OCP alone group. However, the TT and FT did not change significantly between the two groups. Regarding the lipid metabolism outcomes, TC, LDL-C, and TG levels were reduced and HDL-C level was increased in the combination group. Regarding the insulin metabolism outcomes, FINS and HOMA-IR levels were reduced in combination group than in OCP group. The ovulation rate, pregnancy rate, and overall effective rate were significantly higher in combination group than in OCP alone group. Fewer complications were observed in the combination group than in OCP group, and the difference between them was significant., Conclusion: This combination treatment of OCP and orlistat was more effective than OCP alone in reducing the weight, hormonal, lipid, and insulin metabolism profiles, as well as improving the ovulation rate, pregnancy rate, and overall effective rate, as compared with OCP alone., (© 2022 Japan Society of Obstetrics and Gynecology.)

Polycystic ovarian syndrome (PCOS) is a multi-system endocrinopathy that affects women of reproductive age. Due to features that coincide with puberty, it frequently remains undiagnosed in adolescent females. The lack of evidence on management alternatives has resulted in significant variation in practice. This systematic review evaluated the therapeutic advantages and adverse effects of a regularly used therapy option, combined oral contraceptive pills (COC/OCP) with spironolactone (SP), a newer alternative that may be used alone or in conjunction with other drugs to treat adolescent PCOS. A literature search was conducted using PubMed, PubMed Central, Scopus, and Google Scholar. It was restricted to studies published in English between 2021 and 2011 that discussed the management of adolescent PCOS with COC, SP, or both. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Two reviewers independently examined the content of the included studies using appropriate quality assessment tools. Four meta-analyses, four randomized controlled trials (RCTs), and one traditional review were found to be eligible. After extensive analysis, we concluded that SP, alone or in combination, is far safer than COC. However, COC treats more PCOS-associated symptoms than SP, including acne and menstrual irregularities, while also providing contraceptive benefits. However, SP monotherapy is cardioprotective and therapeutic when combined with other drugs. Long-term COC use has been linked to an increased risk of venous thromboembolism, hypertension, dyslipidemia, low-density lipoprotein (LDL) elevation, dysglycemia, and cancer in women., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Rajashekar et al.)

Clinical Scenario: Due to the Female Athlete Triad (Triad) being a 3-pronged syndrome, treatments can vary depending on the symptoms that clinicians focus on. With reproductive and bone health compromised, assessment and recovery methods include monitoring menstrual regularity and dual-energy X-ray absorptiometry scans. Low levels of estrogen have demonstrated negative effects on bone mineral density (BMD). Clinical Question: Does supplemental estrogen improve BMD in athletes with Female Athlete Triad symptoms? Summary of Key Findings: Supplemental estrogen does improve BMD with estrogen patches demonstrating increased improvement compared with oral contraceptive pills. Clinical Bottom Line: Restoration of regular menstruation, improvement of BMD, and ensuring optimal energy levels is the best approach for treating Triad symptoms. Transdermal patches are a new treatment option that address both menstrual function and BMD but still require further research. Strength of Recommendation: Available studies demonstrated a level 2 evidence for supplemental estrogen (oral contraceptive pills and estrogen patches) providing improvements for bone health related to the Triad.

Oral contraceptive pills (OCPs) have a known prothrombotic effect. Obliterative portal venopathy (OPV) can be seen in patients with underlying hypercoagulability. We present a case of a 19-year-old female patient taking OCPs who presented with obstructive jaundice. Her main concern was pruritis. An extensive workup was done to reach a diagnosis but it came back negative. A liver biopsy showed OPV. This was thought secondary to her OCP use. Her OCPs were discontinued which resulted in a complete resolution of her symptoms and laboratory abnormalities. Cases with a direct relationship between OPV and OCP use are extremely rare. More studies are required to establish a correlation between OPV and OCPs. OPV should be considered in the differential diagnosis among patients with obstructive jaundice without an obvious cause, especially in patients taking OCPs. Treatment is stopping the OCPs with close follow-up to confirm disease resolution., Competing Interests: There is no conflict of interest to be reported in this case report by any of the authors., (Copyright 2021, Ashraf et al.)

Retinal vascular occlusion is the most common cause of retinopathy leading to severe visual loss in all age groups. Central retinal vein occlusion (CRVO) is usually seen in older age group and is often associated with systemic vascular diseases. Although the exact cause and effect relationship has not been proven, central retinal vein occlusion has been associated with various systemic pathological conditions, hence a direct review of systems toward the various systemic and local factors predisposing the central retinal vein occlusion is advocated. We describe the development of central retinal venous occlusion with associated cystoid macular edema (CME) in two healthy infertile women who were recruited for in vitro fertilization cycle for infertility. Predisposing risk factors associated with central retinal vein occlusion are obesity, sedentary life style, smoking, and some systemic diseases such as hyperlipidemia, hypertension, associated autoimmune disorders e.g., antiphospholipid antibody syndrome, lupus, diabetes mellitus, cardiovascular disorders, bleeding or clotting disorders, vasculitis, closed-head trauma, alcohol consumption, primary open-angle glaucoma or angle-closure glaucoma.In our patients, they were ruled out afterdoing allpertaining investigations. The cases were managed with further avoidance of oral contraceptives and intra-vitreal injections of Bevacizumab (Avastin), an anti-vascular endothelial growth factor (anti-VEGF drug) and Triamcinolone acetonide (a long acting synthetic steroid). Hence, even if no systemic diseases are detected. Physical examinations are recommended periodically for young women on oral contraceptive pills. [ABSTRACT FROM AUTHOR]