title: Hormonal contraception and pelvic floor function: a systematic review.
abstract: OBJECTIVE
  Hormonal contraceptive use is common practice worldwide. Although the effects of hormone treatments in the pelvic region are well established, there is no clear evidence regarding their effects on incontinence, bladder, bowel, vaginal and sexual symptoms in premenopausal women. We hypothesized that hormonal contraceptives affect pelvic floor function. We therefore performed a comprehensive systematic review of published studies to determine the influence of hormonal contraception on pelvic floor functions.
  
  
  METHODS
  Electronic literature databases were searched from database inception to March 2015. Keywords and medical subject headings searched for included terms and word variations for 'contraception', and 'bowel', 'vaginal', 'sexual' and 'urinary' symptoms. Studies were eligible if they looked at these symptoms in women taking hormonal contraception. Two reviewers independently screened studies for inclusion, and extracted data on study characteristics, quality and results. Data were combined where possible.
  
  
  RESULTS
  Of the 429 citations identified, 13 studies were included in the review. Data were meta-analysed where possible and presented as prevalence. The results indicate statistically significant links between interstitial cystitis and oral contraceptive use at any point (ever) (OR 2.31, 95 % CI 1.03 - 5.16; p = 0.04) and vulvar vestibulitis and current oral contraceptive use (OR 2.10, 95 % CI 1.26 - 3.49; p = 0.004). The evidence is unclear in other areas.
  
  
  CONCLUSIONS
  Our results indicate that oral contraceptives may have an effect on pelvic floor function. They could increase the risk of painful bladder and vulvar vestibulitis, but their effect on dyspareunia is inconsistent. However, robustly collected prospective data to establish causal associations are needed.
authors.affiliation: Birmingham Clinical Trials Unit, College of Medicine and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. r.champaneria@bham.ac.uk.
authors.forename: Rita
authors.initials: R
authors.lastname: Champaneria
authors.affiliation: Eva Peron School Hospital, National University of Rosario, Rosario, Argentina.
authors.forename: Ruben Mamprin
authors.initials: RM
authors.lastname: D'Andrea
authors.affiliation: Academic Department of Obstetrics & Gynaecology, College of Medicine and Dental Sciences, Birmingham Women's Hospital, University of Birmingham, Metchley Park Road, Edgbaston, Birmingham, B15 2TG, UK.
authors.forename: Pallavi M
authors.initials: PM
authors.lastname: Latthe
mesh_terms: D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D018856:Cystitis, Interstitial / Q000453:epidemiology*; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D004414:Dyspareunia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D017773:Pelvic Floor / Q000503:physiopathology; D017697:Premenopause; D056650:Vulvodynia / Q000453:epidemiology
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
keywords: Bowel; Contraception; Oral; Sexual; Urinary; Vaginal