Contraception and menopusal hormone treatment

The projects within the research group are focused on different aspects of contraception and on menopausal hormone therapy (MHT)

1. The relation between use of different contraceptives and the risk of infection with human papilloma virus (HPV), cervical dysplasia and in the end the risk of developing cervical cancer. Previous systematic reviews have shown a clear correlation between use of combined hormonal contraceptives and an increased risk of cervical cancer. On the other hand other systematic reviews have found a protective effect of use of intrauterine devices on the risk of cervical cancer. Most studies have not been able to separate between use of different kinds of IUDs but there are indications pointing at lower risk får, in the first hand, use of copper IUDs. Our research is now focused on use of copper IUD and the subsequent risk of HPV-infections ( a prerequisite for cervical cancer) and dysplasia. Moreover, we plan to study uptake of copper in cervical tissue as well as effects of copper on HPV-associated oncoproteins.

2. Despite a high access to contraceptive services and high availability to highly effective contraceptive methods, many women and couples do not use high effective contraception ant thus are at a risk of unintended pregnancies. Insufficient contraceptive counselling has been identified. In recent years, especially after the covid-19 pandemic, the use of telemedicine has increased rapidly bur there is a lack of studies comparing telemedicine with traditional appointments, especially within the field ocf contraceptive counselling. In a randomized controlled trial we now aim to compare contraceptive counselling via telemedicine with counselling during a. traditional appointment. The outcomes include choice and uptake of high effective contraceptive methods, patient satisfaction, and pregnancies within two years. Moreover, the experiences among midwives ant participating women will be explored using qualitative methods.

3. 1-2% of all women reach menopause before 40 years of age – premature ovarian insufficiency (POI). Moreover, a substantial number of women will for different medical reasons have both ovaries extirpated during surgery before the age of 40 and thus reach a “surgical premature menopause”. If not treated with MHT these women run an increased risk of cardiovascular disease and osteoporiosis and as a consequence may have a higher morbidity and mortality risk in the future. Women in both these groups are recommended use of female sex hormones – MHT – in order to counteract these increased risks. However, previous studies have shown a substantial under treatment. Many women ar never prescribed MHT or choose to stop the treatment for unclear reasons. We now aim to further explore the magnitude of this undertreatment. We also aim to explore physician’s reasons for not prescribing MHT as well as women’s reasons for not using the therapy. We also aim to validate undertake new register studies including validation of registers. We will also usa data from the big prospective SCAPIS-cohort in order to study objective cardiovascular outcomes in women with POI.

Collaborations
Niklas Envall, KI
Anna-Clara Spetz Holm, Linköpings University
Micaela Sundell, Linköpings University
Annika Idahl, Umeå University
Carl-Johan Östgren, Linkpings University