Hormonal contraception is associated with a reduced risk of bacterial vaginosis: a systematic review and meta-analysis.

Abstract

OBJECTIVE:

To examine the association between hormonal contraception (HC) and bacterial vaginosis (BV) by systematic review and meta-analysis.

METHODS:

Medline, Web of Science and Embase databases were searched to 24/1/13 and duplicate references removed. Inclusion criteria 1) >20 BV cases; 2) accepted BV diagnostic method; 3) measure of HC-use either as combined oestrogen-progesterone HC (combined), progesterone-only contraception (POC) or unspecified HC (u-HC); 4) ≥ 10% of women using HC; 5) analysis of the association between BV and HC-use presented; 6) appropriate control group. Data extracted included: type of HC, BV diagnostic method and outcome (prevalent, incident, recurrent), and geographical and clinic-setting. Meta-analyses were conducted to calculate pooled effect sizes (ES), stratified by HC-type and BV outcome. This systematic review is registered with PROSPERO (CRD42013003699).

RESULTS:

Of 1713 unique references identified, 502 full-text articles were assessed for eligibility and 55 studies met inclusion criteria. Hormonal contraceptive use was associated with a significant reduction in the odds of prevalent BV (pooled effect size by random-effects [reES] = 0.68, 95%CI0.63-0.73), and in the relative risk (RR) of incident (reES = 0.82, 95%CI:0.72-0.92), and recurrent (reES = 0.69, 95%CI:0.59-0.91) BV. When stratified by HC-type, combined-HC and POC were both associated with decreased prevalence of BV and risk of incident BV. In the pooled analysis of the effect of HC-use on the composite outcome of prevalent/incident/recurrent BV, HC-use was associated with a reduced risk of any BV (reES = 0.78, 95%CI:0.74-0.82).

CONCLUSION:

HC-use was associated with a significantly reduced risk of BV. This negative association was robust and present regardless of HC-type and evident across all three BV outcome measures. When stratified by HC-type, combined-HC and POC were both individually associated with a reduction in the prevalence and incidence of BV. This meta-analysis provides compelling evidence that HC-use influences a woman's risk of BV, with important implications for clinicians and researchers in the field.

• Authors: Lenka A Vodstrcil, Jane S Hocking, Matthew Law, Sandra Walker, Sepehr N Tabrizi, Christopher K Fairley, Catriona S Bradshaw
• Journal: PloS one (PLoS One) Vol. 8 Issue 9 Pg. e73055 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 24023807 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Hormones

Topics

• Contraception (methods)
• Female
• Hormones (metabolism)
• Humans
• Prevalence
• Risk
• Vaginosis, Bacterial (epidemiology, prevention & control)