Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection
Presented in part at the 35th Annual Meeting of the Society for Epidemiologic Research, Palm Desert, CA, June 18-21, 2002.
Received 18 July 2008; received in revised form 13 October 2008; accepted 16 January 2009.
Objective
The objective of the study was to examine the relationship of depot-medroxyprogesterone acetate (DMPA) and combined oral contraceptive (COC) use with cervical intraepithelial neoplasia (CIN).
Study Design
Two case-control studies of women who presented for gynecologic care and underwent cytologic and human papillomavirus (HPV) testing were performed. The first included oncogenic HPV-positive women grouped based on histology: negative (n = 152), CIN1 (n = 133), and CIN2-3 or greater (n = 173). For the second, 2 groups were identified: negative HPV/negative histology (n = 107) and positive oncogenic HPV/negative histology (n = 152).
Results
Among oncogenic HPV-positive women, DMPA use was inversely associated with CIN2-3 or greater (adjusted odds ratio [ORadj], 0.4; 95% confidence interval [CI], 0.2-1.1) and CIN1 (ORadj, 0.1; 95% CI, 0.01-0.6); COC use was not associated with either. Among histologically negative women, DMPA use was associated with oncogenic HPV (ORadj, 4.7; 95% CI, 1.4-15.8).
Conclusion
Among women with oncogenic HPV, hormonal contraceptive use was not associated with an increased risk of CIN2-3 or greater. Longer-term DMPA use may attenuate the colposcopic and histologic features of CIN because women reporting such use were more likely than others to have cervical oncogenic HPV without evidence of CIN.
aDepartment of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, WA
bDepartment of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA
cDepartment of Pathology, University of Washington School of Medicine, Seattle, WA
dProgram in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA
eDepartment of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN
Reprints: Tiffany Harris, PhD, New York City Department of Health and Mental Hygiene, 253 Broadway, Room 602, New York, NY 10007
Dr Harris is currently affiliated with the New York City Department of Health and Mental Hygiene, New York, NY.
This study was supported in part by Public Health Service Grant CA34493 from the National Cancer Institute.
Cite this article as: Harris TG, Miller L, Kulasingam SL, et al. Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection. Am J Obstet Gynecol 2009;200:489.e1-489.e8.
ABSTRACT
Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection