Abstract
Background
With dramatic improvements in life expectancy for cystic fibrosis (CF) patients, contraception
for women with CF has become an important issue. There are theoretical concerns that
hormonal contraceptive use among women with CF may impact disease severity or risk
for other adverse health outcomes, including thrombosis and poor bone health, as well
as concerns that malabsorption or altered drug metabolism might impact contraceptive
effectiveness.
Objective
To evaluate evidence on the safety and effectiveness of contraceptive methods among
women with CF.
Search Strategy
We searched the PubMed database for all articles published from database inception
through October 2015.
Selection Criteria
We included studies that examined measures of disease severity, other health outcomes
or indicators of contraceptive effectiveness among women with CF initiating or continuing
a contraceptive method.
Results
Seven studies met our inclusion criteria. Three observational studies of fair to poor
quality suggest that use of oral contraceptives (OCs) does not negatively impact CF
disease severity, defined as changes in pulmonary function, number of exacerbations
or need for intravenous antibiotics. Three small studies of poor quality reported
on contraceptive failure among women with CF using combined hormonal contraceptives
(combined OCs, patch or ring). One pregnancy was reported in a patch user out of 43
hormonal contraceptive users across all studies. One pharmacokinetic study reported
that women with CF achieve steroid hormone plasma concentrations similar to healthy
women after ingestion of combined OCs.
Conclusions
Limited evidence suggests that hormonal contraceptive use does not negatively impact
disease severity among women with CF and that hormonal contraceptive effectiveness
is not impaired by CF. Studies were limited by small sample sizes and short duration
of follow-up. No studies examined the effect of hormonal contraception on thrombosis
or bone health among women with CF.
Keywords
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References
- Cystic Fibrosis Foundation Patient Registry annual data report, 2012.Cystic Fibrosis Foundation, Bethesda, MD2013
- The cystic fibrosis gender gap: potential roles of estrogen.Pediatr Pulmonol. 2014; 49: 309-317
- Cystic fibrosis: what to expect now in the early adult years.Paediatr Respir Rev. 2012; 13: 206-214
- Contraception in women with cystic fibrosis: a systematic review of the literature.Contraception. 2016; 93: 3-10
- U.S. medical eligibility criteria for contraceptive use, 2010.MMWR Recomm Rep. 2010; 59: 1-86
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- Current methods of the US Preventive Services Task Force: a review of the process.Am J Prev Med. 2001; 20: 21-35
- Oral contraceptives do not appear to affect cystic fibrosis disease severity.Eur Respir J. 2013; 41: 67-73
- Effect of estrogen on pseudomonas mucoidy and exacerbations in cystic fibrosis.N Engl J Med. 2012; 366: 1978-1986
- Use of oral contraceptives in women with cystic fibrosis.Chest. 1984; 86: 863-867
- Pharmacokinetics of contraceptive steroids in patients with cystic fibrosis.Thorax. 1987; 42: 59-64
- Contraceptive practices in women with cystic fibrosis.J Cyst Fibros. 2008; 7: 412-414
- Role of progestational agents in the treatment of undernourished patients with cystic fibrosis.Pediatr Pulmonol. 2000; 29: 244
- Hormonal contraception in female lung transplant recipients: a case series.J Fam Plann Reprod Health Care. 2014; 40: 294-296
- Pharmacokinetics of drugs in cystic fibrosis.Clin Rev Allergy. 1991; 9: 169-210
- Cystic fibrosis-related diabetes: current trends in prevalence, incidence, and mortality.Diabetes Care. 2009; 32: 1626-1631
- Microvascular complications in patients with cystic fibrosis-related diabetes (CFRD).J Cyst Fibros. 2008; 7: 515-519
- Venous thromboembolism in cystic fibrosis.Pediatr Pulmonol. 2012; 47: 105-112
- The prevalence of osteoporosis, osteopenia, and fractures among adults with cystic fibrosis: a systematic literature review with meta-analysis.Calcif Tissue Int. 2010; 86: 1-7
- Progestogen-only contraception and bone mineral density: a systematic review.Contraception. 2006; 73: 470-487
- Guide to bone health and disease in cystic fibrosis.J Clin Endocrinol Metab. 2005; 90: 1888-1896
- Orkambi [package insert].Vertex Pharmaceuticals Incorporated, Boston, MA2016
Article info
Publication history
Published online: June 07, 2016
Accepted:
May 29,
2016
Received in revised form:
May 27,
2016
Received:
February 12,
2016
Footnotes
☆The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc.
