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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(04): 196-202
DOI: 10.1055/s-0038-1642603
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Association between Hormonal Contraception and Injuries Induced by Human Papillomavirus in the Uterine Cervix

Associação entre a contracepção hormonal e lesões induzidas pelo vírus do papiloma humano no colo uterino
Lia Karina Volpato
1   Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
,
Isabela Ribeiro Siqueira
1   Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
,
Rodrigo Dias Nunes
1   Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
,
Anna Paula Piovezan
1   Post-Graduation Program in Health Sciences, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
› Author Affiliations
Further Information

Publication History

14 December 2017

08 March 2018

Publication Date:
27 April 2018 (online)

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Abstract

Objective To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina.

Methods A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ2) test was used for the qualitative variables, and the Student t-test, for the quantitative variables.

Results When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presenting with low-grade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed.

Conclusion Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality.

Resumo

Objetivo Avaliar a associação entre a contracepção hormonal e a presença de lesões induzidas pelo vírus do papiloma humano (HPV) no colo uterino de pacientes do serviço de ginecologia e obstetrícia do ambulatório de especialidade médicas da Universidade do Sul de Santa Catarina - AME/UNISUL.

Métodos Estudo observacional do tipo caso-controle, com mulheres no menacme, no período compreendido entre 2012 e 2015. Foram incluídas 101 pacientes com lesões cervicais secundárias ao HPV, no grupo caso, e 101 pacientes com colpocitologia oncótica normal, no grupo controle. Os dados foram analisados por meio do programa SPSS 24.0, utilizando-se o intervalo de confiança de 95%. Para testar a homogeneidade de proporções foram utilizados o teste do qui-quadrado (χ2) para as variáveis qualitativas e o teste t de Student para as variáveis quantitativas.

Resultados Ao comparar-se a ocorrência das lesões pelo HPV em usuárias de contraceptivos orais combinados (COCs) com a em não usuárias, observou-se a associação com doses de 0.03 mg ou superiores de etinilestradiol (EE), na qual se identificou 1.9 vezes mais probabilidade destas desenvolverem lesões cervicais induzidas pelo HPV (p = 0.039); ao separar-se esses casos pelo grau da lesão, a probabilidade destas pacientes apresentarem lesão cervical de baixo grau foi 2.1 vezes maior (p = 0.036), porém sem impacto nas lesões cervicais de alto grau e na ocorrência de câncer invasor. Não foram encontradas diferenças significativas nas outras variáveis analisadas.

Conclusão Embora os resultados encontrados no presente estudo sugiram maior probabilidade das usuárias de contraceptivo hormonal combinado, com concentração superior a 0.03 mg de EE, desenvolverem lesão cervical de baixo grau, mais estudos são necessários para concluir causalidade.

Keywords

hormonal contraception - human papillomavirus - HPV - ethinylestradiol

Palavras-chave

contracepção hormonal - vírus do papiloma humano - HPV - etinilestradiol

Contributors

Volpato L. K., Siqueira I. R., Nunes R. D. and Piovezan A. P. contributed with the project and data interpretation, writing of the article, critical review of the intellectual content, and final approval of the version to be published.


 

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