Hormonal contraception and area of cervical ectopy: a longitudinal assessment.
BACKGROUND
The effect of combined oral contraceptives (COCs) and depot-medroxyprogesterone acetate (DMPA) on the area of cervical ectopy is not well understood.


METHODS
From 1996 to 1999, we recruited women not using hormonal contraception from two family planning centers in Baltimore, MD. Upon study entry and 3, 6 and 12 months after the initial visit, participants were interviewed and received visual cervical examinations with photography. Ectopy was measured from digitized photographs and was analyzed both continuously and categorically (small [≤0.48 cm(2)] vs. large [>0.48 cm(2)]).


RESULTS
Of 1003 enrolled women, 802 returned for at least one follow-up visit. At 12 months, the numbers of women using COCs, DMPA or no hormonal method at least 50% of the time since the prior visit were 230, 76 and 229, respectively. After multivariable adjustment, COC use (vs. no hormonal use) was associated with large area of ectopy (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.0-3.3). No significant relationship was observed between DMPA and large area of ectopy (OR: 0.5, 95% CI: 0.2-1.3). The incidence of large area of ectopy by contraceptive exposure (COC, DMPA or no hormonal method) was 17.4 (CI: 11.8-24.6), 10.9 (CI: 4.4-22.4) and 4.6 (CI: 2.2-8.4) per 100 woman-years, respectively.


CONCLUSIONS
Use of COCs, but not DMPA, was associated with large area of cervical ectopy. Area of ectopy at baseline was the strongest predictor of area of ectopy at follow-up.
Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
Patricia L
PL
Bright
Abigail
A
Norris Turner
Charles S
CS
Morrison
Emelita L
EL
Wong
Cynthia
C
Kwok
Irina
I
Yacobson
Rachel A
RA
Royce
Heidi O
HO
Tucker
Paul D
PD
Blumenthal
D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D011446:Prospective Studies; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D017258:Medroxyprogesterone Acetate