title: Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome.
abstract: OBJECTIVE
  Prior studies suggest that the composition of the vaginal microbiome may positively or negatively affect susceptibility to sexually transmitted infections (STIs) and bacterial vaginosis (BV). Some female hormonal contraceptive methods also appear to positively or negatively influence STI transmission and BV. Therefore, changes in the vaginal microbiome that are associated with different contraceptive methods may explain, in part, effects on STI transmission and BV.
  
  
  METHODS
  We performed a retrospective study of 16S rRNA gene survey data of vaginal samples from a subset of participants from the Human Vaginal Microbiome Project at Virginia Commonwealth University. The subset included 682 women who reported using a single form of birth control that was condoms, combined oral contraceptives (COCs), depot medroxyprogesterone acetate (DMPA) or the levonorgestrel-releasing intrauterine system (LNG-IUS).
  
  
  RESULTS
  Women using COCs [adjusted odds ratio (aOR) 0.29, 95% confidence interval (CI) 0.13-0.64] and DMPA (aOR 0.34, 95% CI 0.13-0.89), but not LNG-IUS (aOR 1.55, 95% CI 0.72-3.35), were less likely to be colonized by BV-associated bacteria relative to women who used condoms. Women using COCs (aOR 1.94, 95% CI 1.25-3.02) were more likely to be colonized by beneficial H2O2-producing Lactobacillus species compared with women using condoms, while women using DMPA (aOR 1.09, 95% CI 0.63-1.86) and LNG-IUS (aOR 0.74, 95% CI 0.48-1.15) were not.
  
  
  CONCLUSIONS
  Use of COCs is significantly associated with increased vaginal colonization by healthy lactobacilli and reduced BV-associated taxa.
  
  
  CONCLUSIONS
  COC use may positively influence gynecologic health through an increase in healthy lactobacilli and a decrease in BV-associated bacterial taxa.
authors.affiliation: Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA, USA; Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: jpbrooks@vcu.edu.
authors.forename: J Paul
authors.initials: JP
authors.lastname: Brooks
authors.affiliation: Department of Statistical Sciences and Operations Research, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: dedwards7@vcu.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Edwards
authors.affiliation: Contraception Research Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD. Electronic address: blithed@exchange.nih.gov.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Blithe
authors.affiliation: Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: fettweisjm@vcu.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Fettweis
authors.affiliation: Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: mgserrano@vcu.edu.
authors.forename: Myrna G
authors.initials: MG
authors.lastname: Serrano
authors.affiliation: Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: nsheth@vcu.edu.
authors.forename: Nihar U
authors.initials: NU
authors.lastname: Sheth
authors.affiliation: Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: jerome.strauss@vcuhealth.org.
authors.forename: Jerome F
authors.initials: JF
authors.lastname: Strauss
authors.affiliation: Center for the Study of Biological Complexity, Virginia Commonwealth University, Richmond, VA, USA; Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: gregory.buck@vcuhealth.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Buck
authors.affiliation: Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: kkjefferson@vcu.edu.
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Jefferson
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D003267:Contraception / Q000379:methods*; D003277:Contraceptives, Oral, Combined / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000494:pharmacology*; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology*; D064307:Microbiota / Q000187:drug effects*; D016133:Polymerase Chain Reaction; D012336:RNA, Ribosomal, 16S; D012189:Retrospective Studies; D015231:Sexually Transmitted Diseases, Bacterial / Q000517:prevention & control; D014621:Vagina / Q000187:drug effects*; D016585:Vaginosis, Bacterial / Q000517:prevention & control; D055815:Young Adult
chemical_list: D003277:Contraceptives, Oral, Combined; D012336:RNA, Ribosomal, 16S; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
keywords: Bacterial vaginosis; Hormonal contraceptives; Lactobacilli; Vaginal microbiome