Contraceptive safety among women with cystic fibrosis: a systematic review.
With dramatic improvements in life expectancy for cystic fibrosis (CF) patients, contraception for women with CF has become an important issue. There are theoretical concerns that hormonal contraceptive use among women with CF may impact disease severity or risk for other adverse health outcomes, including thrombosis and poor bone health, as well as concerns that malabsorption or altered drug metabolism might impact contraceptive effectiveness.



To evaluate evidence on the safety and effectiveness of contraceptive methods among women with CF.



We searched the PubMed database for all articles published from database inception through October 2015.



We included studies that examined measures of disease severity, other health outcomes or indicators of contraceptive effectiveness among women with CF initiating or continuing a contraceptive method.



Seven studies met our inclusion criteria. Three observational studies of fair to poor quality suggest that use of oral contraceptives (OCs) does not negatively impact CF disease severity, defined as changes in pulmonary function, number of exacerbations or need for intravenous antibiotics. Three small studies of poor quality reported on contraceptive failure among women with CF using combined hormonal contraceptives (combined OCs, patch or ring). One pregnancy was reported in a patch user out of 43 hormonal contraceptive users across all studies. One pharmacokinetic study reported that women with CF achieve steroid hormone plasma concentrations similar to healthy women after ingestion of combined OCs.



Limited evidence suggests that hormonal contraceptive use does not negatively impact disease severity among women with CF and that hormonal contraceptive effectiveness is not impaired by CF. Studies were limited by small sample sizes and short duration of follow-up. No studies examined the effect of hormonal contraception on thrombosis or bone health among women with CF.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: acq5@cdc.gov.
Maura K
MK
Whiteman
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Titilope
T
Oduyebo
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lauren B
LB
Zapata
Emory University Adult Cystic Fibrosis Program, Atlanta, GA, USA.
Seth
S
Walker
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Kathryn M
KM
Curtis
D003267:Contraception / Q000379:methods*; D003274:Contraceptive Devices, Female; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000493:pharmacokinetics*; D003550:Cystic Fibrosis / Q000503:physiopathology*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D064887:Observational Studies as Topic; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D018570:Risk Assessment
D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal
Contraception; Cystic fibrosis; Effectiveness; Safety; Systematic review