Hormonal contraceptives may delay return to fertility
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Hormonal contraceptives may delay return to fertility Use of some types of hormonal contraceptives prior to pregnancy may delay the return to fertility after treatment discontinuation, according to findings of a study published in the BMJ. Questionnaires were used to investigate the association between pregravid contraceptive use and fecundability over a 12-month period in 17 954 women who had been trying to conceive over up to six menstrual cycles and had participated in the Danus Snart Gravid study between 2007 and 2011, the Danish Snart Foraeldre extension of Snart Gravid between 2011 and 2019, or the US Pregnancy Online Study (PRESTO) between 2013 and 2019. During the observation periods, 10 729 pregnancies were reported over 66 750 menstrual cycles. The most frequently used contraception methods prior to study entry were oral contraceptives (38%), barrier methods (31%) and long-acting reversible contraceptives (13%). Short-term delays in return to fertility were reported in women who stopped using oral contraceptives, a contraceptive ring, and some long-acting reversible contraceptives, compared with those who used barrier methods. In particular, injectable contraceptives significantly reduced the return to fecundability compared with use of barrier methods (fecundability ratio 0.65; 95% CI 0.47, 0.89). The delay in return to normal fertility was 5–8 menstrual cycles in women who had used injectable contraceptives, four cycles in those who had used contraceptive patches, three cycles in those who had used oral or ring contraceptives, and two cycles in those who had used hormonal intrauterine devices (IUDs), copper IUDs or contraceptive implants. No association was found between the total duration of hormonal contraceptive use and fecundability in the PRESTO cohort, but in the Snart Gravid and Snart Foraeldre cohorts there was a trend towards an increase in fecundability with longer total duration of oral contraceptive use. "Our findings suggested that return of normal fertility varies substantially by contraceptive method . . . Understanding the comparative effects of different contraceptives on fecundity is essential for family planning, counselling for contraception, and management of infertility," said the authors. Yland JJ, et al. Pregravid contraceptive use and fecundability: prospective cohort study. BMJ : 11 Nov 2020. Available from: URL: https://doi.org/10.1136/ bmj.m3966
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Reactions 21 Nov 2020 No. 1831
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