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  • Title: The impact of contraceptive methods on the onset of symptomatic vulvovaginal candidiasis within the menstrual cycle.
    Author: Nelson AL.
    Journal: Am J Obstet Gynecol; 1997 Jun; 176(6):1376-80. PubMed ID: 9215201.
    Abstract:
    OBJECTIVE: Vulvovaginal candidiasis is the second most common cause of vaginal discharge. Low-dose oral contraceptives are no longer thought to increase the absolute risk of episodic vulvovaginal candidiasis. This study investigates the possible impact that hormonal contraception may have on the timing of onset of symptoms within the menstrual cycle. STUDY DESIGN: In a retrospective chart review of reproductive-aged women seen at the Women's Health Care Clinic at Harbor-University of California, Los Angeles, Medical Center, data from the records of 448 symptomatic women who had 507 episodes of vulvovaginal candidiasis were extracted and analyzed for timing of onset of symptoms within the menstrual cycle. Diagnosis was based on symptoms, physical findings, and microscopy. Onset was divided into five physiologic ranges within an idealized 28-day menstrual cycle. Comparisons among groups were made with use of chi 2 and p < 0.05 thresholds for statistical significance. RESULTS: No differences were found in the onset of symptoms within the idealized menstrual cycle ranges between women using hormonal birth control methods and those using nonhormonal ones. The distribution was remarkably uniform throughout the cycle with the exception of the first few days (during menses). CONCLUSION: The timing of onset of symptoms of vulvovaginal candidiasis within a woman's menstrual cycle is not affected by her method of birth control. 75% of US women have at least one episode of vulvovaginal candidiasis in their lives and an estimated US$600 million is spent each year on the diagnosis and treatment of this condition. To assess the possible impact of hormonal contraception on the timing of onset of symptoms within the menstrual cycle, a retrospective chart review was conducted of women treated for vulvovaginal candidiasis at the University of California, Los Angeles, Medical Center. A total of 448 women, with 507 symptomatic vulvovaginal candidiasis episodes, were included in the study. All had normal menstrual cycles (21-35 days). 231 of these women were using oral contraceptives containing 30-35 mg of ethinyl estradiol, 8 were using Depo-Provera, and 268 relied on nonhormonal methods. After adjustment for cycle length, analysis was restricted to five intervals in the idealized 28-day cycle: menses (days 1-5), follicular (days 6-11), periovulatory (days 12-17), luteal (days 18-24), and premenstrual (days 25-28). The distribution of onset of symptoms for users of hormonal methods did not differ significantly from that in users of nonhormonal methods. Moreover, there was no clear temporal grouping in the onset of symptoms within the menstrual cycle for any contraceptive group. Improved understanding of the dynamics of vulvovaginal candidiasis would facilitate the identification of strategies to reduce the risk factors and interrupt the transformation process before symptomatic infection develops.
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