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Hormonal contraception and pelvic floor function: a systematic review

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Abstract

Introduction and hypothesis

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.

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Abbreviations

CI:

Confidence Interval

DMPA:

Depot medroxyprogesterone acetate

IC:

Interstitial cystitis

LNG-IUS:

Levonorgestrel intrauterine releasing system

MUI:

mixed urinary incontinence

OAB:

Overactive bladder

OC:

Oral contraception/contraceptive

OR:

Odds ratio

RCT:

Randomized controlled trial

RR:

Relative risk

SUI:

Stress urinary incontinence

UI:

Urinary incontinence

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Acknowledgments

We thank Derick Yates, Clinical Librarian of Birmingham Women’s Hospital NHS Trust, for carrying out the literature searches on our behalf.

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Conflicts of interest

None.

Funding

No funding was sought for this work.

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Authors and Affiliations

  1. Birmingham Clinical Trials Unit, College of Medicine and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

    Rita Champaneria

  2. Eva Peron School Hospital, National University of Rosario, Rosario, Argentina

    Ruben Mamprin D’Andrea

  3. 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

    Pallavi M. Latthe

Authors
  1. Rita Champaneria
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  2. Ruben Mamprin D’Andrea
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  3. Pallavi M. Latthe
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Correspondence to Rita Champaneria.

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Champaneria, R., D’Andrea, R.M. & Latthe, P.M. Hormonal contraception and pelvic floor function: a systematic review. Int Urogynecol J 27, 709–722 (2016). https://doi.org/10.1007/s00192-015-2833-3

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  • DOI: https://doi.org/10.1007/s00192-015-2833-3

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