Research
General gynecology
Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection

Presented in part at the 35th Annual Meeting of the Society for Epidemiologic Research, Palm Desert, CA, June 18-21, 2002.
https://doi.org/10.1016/j.ajog.2009.01.030Get rights and content

Objective

The objective of the study was to examine the relationship of depot-medroxyprogesterone acetate (DMPA) and combined oral contraceptive (COC) use with cervical intraepithelial neoplasia (CIN).

Study Design

Two case-control studies of women who presented for gynecologic care and underwent cytologic and human papillomavirus (HPV) testing were performed. The first included oncogenic HPV-positive women grouped based on histology: negative (n = 152), CIN1 (n = 133), and CIN2-3 or greater (n = 173). For the second, 2 groups were identified: negative HPV/negative histology (n = 107) and positive oncogenic HPV/negative histology (n = 152).

Results

Among oncogenic HPV-positive women, DMPA use was inversely associated with CIN2-3 or greater (adjusted odds ratio [ORadj], 0.4; 95% confidence interval [CI], 0.2-1.1) and CIN1 (ORadj, 0.1; 95% CI, 0.01-0.6); COC use was not associated with either. Among histologically negative women, DMPA use was associated with oncogenic HPV (ORadj, 4.7; 95% CI, 1.4-15.8).

Conclusion

Among women with oncogenic HPV, hormonal contraceptive use was not associated with an increased risk of CIN2-3 or greater. Longer-term DMPA use may attenuate the colposcopic and histologic features of CIN because women reporting such use were more likely than others to have cervical oncogenic HPV without evidence of CIN.

Section snippets

Study subjects and data collection

The University of Washington Human Subjects Division approved all protocols and consent forms. As described previously, women presenting from December 1997 through August 2002 for routine gynecologic care at 3 Planned Parenthood clinics who met the following criteria were eligible for cytologic and HPV screening with the study: were 18-50 years old; had no history of treatment for cervical neoplasia or hysterectomy; were not planning to continue a current pregnancy; and did not report being

Hormonal contraception and CIN

Of the 458 subjects in the analysis who were oncogenic HPV–positive at colposcopy-biopsy, 377 (83%) were also oncogenic HPV–positive at screening, and of these, 345 (92%) were positive for the same type. At colposcopy-biopsy, HPV16 was detected in specimens from 43 (28%) of the women with negative histology, 27 (20%) of the women with CIN1, and 90 (52%) of the women with CIN2-3 or greater. CIN cases were more likely than controls to have 2 or more oncogenic HPV types detected at

Comment

Among women with oncogenic HPV, those with CIN were slightly less likely than women with negative histology to report ever use of DMPA in the previous year (borderline statistical significance for CIN2-3 or greater). COC use was not associated with CIN2-3 or greater or with CIN1. Recent use of DMPA for 1 year or longer was positively associated with detection of oncogenic HPV. This relationship did not appear to be caused by HPV persistence as measured by type-specific repeat oncogenic HPV

Acknowledgment

We thank Planned Parenthood, Kim Tomlinson, Akhila Balasubramanian, and Connie Nelson for their work on the Evaluation of Screening Methods for Cervical Cancer Study and Dr Thomas Lumley for his participation on Dr Harris's dissertation committee.

References (40)

  • P. Appleby et al.

    Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies

    Lancet

    (2007)
  • J.M. Deacon et al.

    Sexual behaviour and smoking as determinants of cervical HPV infection and of CIN3 among those infected: a case-control study nested within the Manchester cohort

    Br J Cancer

    (2000)
  • J. Green et al.

    Human papillomavirus infection and use of oral contraceptives

    Br J Cancer

    (2003)
  • R.L. Winer et al.

    Incident infection with genital human papillomavirus: rates and risk factors in a cohort of college women

    Am J Epidemiol

    (2003)
  • A.B. Moscicki et al.

    Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females

    JAMA

    (2001)
  • A.R. Giuliano et al.

    Human papillomavirus infection at the United States-Mexico border: implications for cervical cancer prevention and control

    Cancer Epidemiol Biomarkers Prev

    (2001)
  • P.E. Castle et al.

    Hormonal contraceptive use, pregnancy and parity, and the risk of cervical intraepithelial neoplasia 3 among oncogenic HPV DNA-positive women with equivocal or mildly abnormal cytology

    Int J Cancer

    (2005)
  • S. Vaccarella et al.

    Reproductive factors, oral contraceptive use, and human papillomavirus infection: pooled analysis of the IARC HPV prevalence surveys

    Cancer Epidemiol Biomarkers Prev

    (2006)
  • S. Shapiro et al.

    Risk of invasive cancer of the cervix in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen oral contraceptives (South Africa)

    Cancer Causes Control

    (2003)
  • S.L. Kulasingam et al.

    Evaluation of human papillomavirus testing in primary screening for cervical abnormalities: comparison of sensitivity, specificity, and frequency of referral

    JAMA

    (2002)
  • Cited by (25)

    • Solid fuel use for heating and risks of breast and cervical cancer mortality in China

      2020, Environmental Research
      Citation Excerpt :

      We assumed that some estrogen-like chemicals released from solid fuel combustion (especially PAHs), after entering into cervical tissue, might increase a woman's risk of developing cancer. On the contrary, progesterone was inhibitory for cervical carcinogenesis in vivo and associated with a reduced cancer risk among HPV-infected women (Baik et al., 2019; Harris et al., 2009; Yoo et al., 2013). For post-menopausal women with low level of sex hormones, potential preventive effect of progesterone may be attenuated.

    • Oral contraceptives use and risk of cervical cancer—A systematic review & meta-analysis

      2020, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      Full details of the 19 studies included in the analysis were given in Web Table 1. A separate analysis was also done on 15 studies for OC pill use and risk of cervical cancer in HPV positive women [21,24,34,38–49] and included as a web source. A summary of included studies for study location along with the period of study, study design, sample size, study setting, and case ascertainment for each primary study were enlisted (Web Table 1).

    • Canadian Contraception Consensus (part 3 of 4): Chapter 8 - Progestin-only contraception

      2016, Journal of Obstetrics and Gynaecology Canada
      Citation Excerpt :

      Son utilisation ne semble pas engendrer une hausse des risques de cancer du sein197–200. Les résultats d’études récentes quant au cancer du col utérin sont rassurants et indiquent que ce cancer est associé au tabagisme plutôt qu’à l’utilisation d’AMPR201–204. Déclaration sommaire

    • Canadian Contraception Consensus (Part 3 of 4): Chapter 8 - Progestin-Only Contraception

      2016, Journal of Obstetrics and Gynaecology Canada
      Citation Excerpt :

      There does not appear to be an increased risk of breast cancer with DMPA use.197–200 Recent studies regarding cervical cancer are reassuring and show that cervical cancer is associated with smoking status rather than DMPA use.201–204 Summary Statement

    View all citing articles on Scopus

    Dr Harris is currently affiliated with the New York City Department of Health and Mental Hygiene, New York, NY.

    This study was supported in part by Public Health Service Grant CA34493 from the National Cancer Institute.

    Cite this article as: Harris TG, Miller L, Kulasingam SL, et al. Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection. Am J Obstet Gynecol 2009;200:489.e1-489.e8.

    View full text