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  • Title: Smoking and cycle control among oral contraceptive users.
    Author: Rosenberg MJ, Waugh MS, Stevens CM.
    Journal: Am J Obstet Gynecol; 1996 Feb; 174(2):628-32. PubMed ID: 8623797.
    Abstract:
    OBJECTIVE: Because cigarette smoking has a variety of antiestrogenic actions, we investigated the possibility that smoking may adversely affect spotting and bleeding among women using oral contraceptives. STUDY DESIGN: Three open-label, randomized clinical trials involving 16,506 cycles among 2956 oral contraceptive users were performed. RESULTS: Smokers reported a consistently higher frequency of spotting or bleeding than did nonsmokers. After recency and consistency of oral contraceptive use and progestin component were controlled for, smokers were, on average, 47% more likely to have spotting or bleeding than nonsmokers were over six cycles of oral contraceptive use, with higher levels of smoking associated with a greater frequency of spotting or bleeding. By the sixth cycle women who smoked > or = 16 cigarettes per day were almost three times more likely to have spotting or bleeding than were nonsmokers. CONCLUSION: Cigarette smoking adversely affects cycle control among oral contraceptive users, possibly by increasing estrogen catabolism. Although these findings also raise the possibility that oral contraceptive efficacy may also be impaired in smokers, an immediate concern is that oral contraceptive users who have spotting and bleeding are more likely to discontinue their use, placing them at risk of unintended pregnancy. Three open-label, randomized clinical trials involving 16,506 cycles among 2956 oral contraceptive (OC) users were conducted in order to investigate whether smoking may adversely affect spotting and bleeding among women using OCs. Included were 1480 women and 8292 cycles of experience with gestodene preparations, 1384 women and 7691 cycles with OCs containing desogestrel, and 92 women and 523 cycles with the norgestimate preparation. Among smokers, the proportion who reported spotting or bleeding varied from 59% in the first cycle to 14% in the sixth cycle, averaging 23%. In contrast, the proportion of nonsmokers who reported bleeding ranged from 52% in the first cycle to 9% in the sixth cycle, averaging 19% for all six cycles. Although the proportion of smokers and nonsmokers with spotting or bleeding decreased significantly with time (p = .000), nonsmokers had a slight but consistent increase in spotting or bleeding for each cycle after the first, whereas spotting or bleeding in smokers decreased during the first two cycles and remained constant thereafter. After recency and consistency of OC use and progestin components were controlled for, smokers were 47% more likely to have spotting or bleeding than nonsmokers over six cycles of OC use with higher levels of smoking associated with a greater frequency of spotting or bleeding. By the sixth cycle women who smoked or= 16 cigarettes/day were almost three times more likely to have spotting or bleeding than nonsmokers. For women with any smoking, the relative risk (RR) was elevated for every cycle, with the difference being significant in five of six cycles. The RR for any smoking varied from 1.30 in the first cycle (an increase in risk of 30% compared with nonsmokers) to 1.86 (86% increase) by cycle six. Cigarette smoking adversely affects cycle control among OC users, possibly by increasing estrogen catabolism. Women who have spotting or bleeding are more likely to discontinue OC use, which places them at increased risk of unintended pregnancy.
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