title: Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting?
abstract: BACKGROUND
  The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives.
  
  
  OBJECTIVE
  To determine the association between hormonal contraceptives and cervical neoplasia.
  
  
  METHODS
  This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence.
  
  
  RESULTS
  A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were ≥35 years old (6% versus 1%, P<0.0001), rural dwellers (6% versus 3.5%, P<0.0001), unmarried (7.6% versus 3.5%, P<0.0001), unemployed (6.8% versus 3.5%, P<0.0001), less educated (6% versus 3.8%, P<0.0001), and had high parity (6.8% versus 3.6%, P<0.0001). There was no statistical significant difference in cervical neoplasia between the two groups of participants (7 [4.5%] versus 6 [3.8%], P=1.0).
  
  
  CONCLUSIONS
  There was no association between hormonal contraceptives and cervical neoplasia in this study.
authors.affiliation: Department of Obstetrics and gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria ; Department of Obstetrics and gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Leonard Ogbonna
authors.initials: LO
authors.lastname: Ajah
authors.affiliation: Department of Obstetrics and gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Chibuike Ogwuegbu
authors.initials: CO
authors.lastname: Chigbu
authors.affiliation: Department of Obstetrics and gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Benjamin Chukwuma
authors.initials: BC
authors.lastname: Ozumba
authors.affiliation: Department of Obstetrics and gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Theophilus Chimezie
authors.initials: TC
authors.lastname: Oguanuo
authors.affiliation: Department of Obstetrics and gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Paul Olisaemeka
authors.initials: PO
authors.lastname: Ezeonu
keywords: Enugu; Nigeria; cervical neoplasia; hormonal contraceptives