Interesting aspects of contraception

This 2nd day seminar looked into interesting aspects of contraception, specifically the myelin-repairing activity of progsterone in contraception, the association between COCs and menstrual migraines; and contraceptive options in women with epilepsy.

Progesterone in contraception found to repair brain tissue

Reproductive endocrinologist Regine Sitruk-Ware, of the population council, explained that her work with Roberta Diaz Brinton had found progesterone and certain progestins, excluding MPA, regulate neurogenic and neuroprotective responses. A number of studies have shown that progesterone acts on progesterone receptors to provide multiple non-reproductive functions in the body including regulating cognition, mood, inflammation, mitochondrial function, neurogenesis and regeneration, myelination and recovery from traumatic brain injury. With both in Vitro and in Vivo studies demonstrating progesterone and nesterone’s positive effects on myelin repair, this surely warrants the need for further studies in this area.

The Menstrual Migraine

Professor Merki-Field explained that women are 3x more likely to suffer migraines than men. Half of female migraines are associated with the menstrual cycle, being most likely to occur in the 2 days prior to menstruation or 3 days, during when the oestrogen levels drop. The Combined Oral Contraceptive Pill (COC) is significantly associated with migraines – either initiating, increasing the frequency and intensity of attacks or initiating aura migraine in prevously non-aura migrainers. Additionally COC increases ischemic stroke risk, as repeated migraines cause brain lesions, the CAMERA II study demonstrated these steadily progress in women specifically over time.

How to treat the menstrual migraine

Menstrual migraines are difficult to treat with pain medication as they frequently do not respond. These migraines are typically longer lasting and can have a severe impact on a woman’s quality of life – patients that take pain medication can overuse (take for 10 or more, or 15 or more days a month, depending on the medication) and are at risk of developing overuse headaches. A preferred option would be oestrogen patches and gel, to replace lost oestrogen in the hormone free interval, together with a progesterone only contraceptive pill. Short-term prevention can be achieved with triptans, 2-3 doses a day from 2 days prior to menstruation until 3-4 days during. A short-term course reduces the risk of developing medication-overuse headaches, defined as a headache occurring on 15 or more days per month. The drawback with this therapy is that natural cycles are not always predictable and therefore patients may begin taking the triptans too early or too late.

Contraception in WWE (Women With Epilepsy)

The interaction between EiAED (Enzyme-Inducing Anti-epileptic drugs) and COCs is well-documented. With a bidirectional action, both are able to reduce the effects of each other, therefore the risk of contraceptive failure is high (50% of WWE pregnancies are unplanned) and an adverse effect is seen on seizure activity. Additionally many EiAEDs are not recommended in pregnancy due to negative effects on the foetus. Considering this - barrier methods, rather than hormonal,  provide a more effective contraception option in WWE.