Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection.
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).


METHODS
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 [OR(adj)], 0.4; 95% confidence interval [CI], 0.2-1.1) and CIN1 (OR(adj), 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 (OR(adj), 4.7; 95% CI, 1.4-15.8).


CONCLUSIONS
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.
Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA. tharris@health.nyc.gov
Tiffany G
TG
Harris
Leslie
L
Miller
Shalini L
SL
Kulasingam
Qinghua
Q
Feng
Nancy B
NB
Kiviat
Stephen M
SM
Schwartz
Laura A
LA
Koutsky
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology*; D012307:Risk Factors; D014412:Tumor Virus Infections / Q000453:epidemiology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000821:virology
D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate