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Hormonal Contraception Is Associated with a Reduced Risk of Bacterial Vaginosis: A Systematic Review and Meta-Analysis

Author

Listed:
  • Lenka A Vodstrcil
  • Jane S Hocking
  • Matthew Law
  • Sandra Walker
  • Sepehr N Tabrizi
  • Christopher K Fairley
  • Catriona S Bradshaw

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.

Suggested Citation

  • Lenka A Vodstrcil & Jane S Hocking & Matthew Law & Sandra Walker & Sepehr N Tabrizi & Christopher K Fairley & Catriona S Bradshaw, 2013. "Hormonal Contraception Is Associated with a Reduced Risk of Bacterial Vaginosis: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-16, September.
    • Handle: RePEc:plo:pone00:0073055
    DOI: 10.1371/journal.pone.0073055
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    References listed on IDEAS

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    1. Catriona S Bradshaw & Jennifer Walker & Christopher K Fairley & Marcus Y Chen & Sepehr N Tabrizi & Basil Donovan & John M Kaldor & Kathryn McNamee & Eve Urban & Sandra Walker & Marian Currie & Hudson , 2013. "Prevalent and Incident Bacterial Vaginosis Are Associated with Sexual and Contraceptive Behaviours in Young Australian Women," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Holzman, C. & Leventhal, J.M. & Qiu, H. & Jones, N.M. & Wang, J., 2001. "Factors linked to bacterial vaginosis in nonpregnant women," American Journal of Public Health, American Public Health Association, vol. 91(10), pages 1664-1670.
    4. Artz, L. & Macaluso, M. & Brill, I. & Kelaghan, J. & Austin, H. & Fleenor, M. & Robey, L. & Hook III, E.W., 2000. "Effectiveness of an intervention promoting the female condom to patients at sexually transmitted disease clinics," American Journal of Public Health, American Public Health Association, vol. 90(2), pages 237-244.
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