The Efficiency and Long-Term Effects of Oral Contraceptives - Case Study Example

Introduction The research is based on a longitudinal study of 121,701 women for a period of 36 years both who were ever users as well as never users of oral contraceptives. The population of this research was married nurses whom were either using or not using the oral contraceptives or they had been using it then they stopped at some point during the entire period of the research. The aim of the study was to find out whether oral contraceptives use was associated with mortality that was cause-specific or one that was all cause among the two main study populations. The results were collected twice in a year from the Nurses’ Health Study. The study used the prospective cohort study design throughout the research in order to examine the results of the data. The results indicated that the mortality between the two cohorts of ever users and non-users both suffered mortality. The disadvantage with this research and which is part of its greatest weakness is that despite the great longitudinal research and analysis, the research is based only in US and hence the results cannot be generalized globally. However the all-cause mortality was established to take place among the never users of the oral contraceptives while the ever users did not suffer any mortality. When it came to specific mortality the ever users suffered more from violent as well as accidental deaths than the never users (Charlton, et al. 2014). The authors have just mentioned that even though their research on the long term effects of oral contraceptives use has never been addressed, there are other papers which have mentioned the various health risks associated with the use of oral contraceptives. These papers and their references have however not been analyzed further and how they may have contributed to the results of this research. The Royal College ofGeneral Practitioners research for example discusses about the mortality risk women face when using the oral contraceptives which is different from what never users of the contraceptives face. The results of these two studies are similar in every way the only difference being one was carried out in UK and this one in the US (Hannaford, et al. 2010). The paper on the Oxford-Family Planning Association contraceptive program with almost similar aims was also missing. These two studies would have made the perfect background for this research and for the readers to have a clue of what was taking place and hence a better understanding of the results. More literature research for the sake of providing more support and convincing the readers of the need for the research as well as the important purpose it serves in the society up to date is necessary. This also forms one of the limitations of the research in the long run. There have been little or no significant changes in the mortality rates of the ever users and never users of the oral contraceptives in the research. This may be because the research is recent and the health care organizations are yet to fully comprehend the impact of these mortality rate figures as well as the whole research information. The other reason that may cause the delay in taking action is the fact that the results of the research as well as the other two mentioned above have focused primarily on the US and European nations making the results not generalizable to other nations and especially those in Asia and Africa who may be facing different problems than what the research is focusing on (Charlton, et al. 2014). More time should be allowed to repeat the research in these other continents before a reaction can be heard as well as await formulation of policies to address the issue in these two continents that have the results. The research questions aimed to find out whether the general mortality rate among the ever users of the oral contraceptives would be significantly lower than that of the never users. The other research question was on what would be causes of the mortality in the ever users and especially those that had stopped using the oral contraceptives at some point in time and then resumed taking them. A further research question was on whether the mortality rate would decrease for the more recent users of the oral contraceptives compared to that of the users that had stayed longer periods without using the oral contraceptive pills. Methods The methodology used to determine the population to participate in the research was simply nurses that were married, were between 30-55 years of age, and prior to the research had no personal history of breast cancer. As for the issue of whether they were using oral contraceptives or not, it was assumed that during this time most married women using any form of protection was through the oral contraceptives or none at all. Follow up throughout the whole 36 years which was the entire period that the research lasted was carried out using questionnaires which were provided biennially to this population and the information updated in the original information provided. The study design employed in this research was prospective cohort study. There were however over one hundred women that were dropped from the initial list of the population letting the population that was covered by the study design at 121 577. This type of study design used was carried out in researches that were longitudinal as well as those that used a similar age group of participants. The study design was also purely to be used on researches dealing with medical or general healthcare issues. As it was prospective, this meant that whatever was being sought after in terms of a health condition was not previously diagnosed in the study population prior to the research commencing (Macera, Shaffer & Shaffer, 2012). When examining this research and comparing it against the characteristics requirements of this study design, it is evident that it was appropriate. The research was dealing with oral contraceptives use and never use which was a health care issue and it was carried out for 36 years hence making it a longitudinal study. The fact that the population was a group of nurses who had been tested and verified not to have breast cancer prior to the research seals the deal of approval and appropriateness. The research by Hannaford, et al. (2010) also utilized the prospective cohort study design. This was because it took 39 years before it was finalized. The population was women from the Royal College of General Practitioners and they were all tested for any diseases prior to the research and it involved the use of oral contraceptives which was a health care issue. This research by Beaber, et al. (2014) utilized the nested case-control study which utilized only a few subsets of controls which were selected randomly from the population in study. It was carried out in 1102 women out of the population of 21952. It is less effective than the full case control but it is faster and less expensive. Research by Clark, et al. (2014) utilized the cohort study design where the population was required to be divided into different cohorts which would make the analysis easier on the researchers rather than carry out general and blind analysis on the entire population. It was still a health research based on oral contraceptives but the women were divided and analyzed differently. This last study was extremely different as it utilized the survey design study that did not require it to be a health care research nor be a longitudinal one like the cohort study designs did. The research was however based on oral contraceptives and the violence effects on women (Tsilidis, K. et al. 2011). The good thing about this research design compared to the one in the study is that it enables determination of the quality of the research. The similarity is that it employs the use of questionnaires to gather data. Results Results indicated that by the end of the research study, there 31286 deaths on both cohort groups: the never users and the ever users. From all these deaths, 11781 were from cancer, 6032 from cardiovascular diseases, 855 from digestive diseases, 1084 from violence and accidents while 9212 were from other diseases altogether. The general differences in death mortality had no significant difference between the never users and ever users apart from data on the violent and accidental deaths as well as that from the cancers. When it came to violent and accidental deaths, the ever users had more statistics compared to the never users. However, on the issue of cancers which incorporated breast and ovarian cancers, the never users rated highly than the ever users. The same statistics were witnessed among the other diseases as well as on the cerebrovascular diseases. The longer the women used the oral contraceptives, the lesser their mortality rates in relation to cancer death. These results are very accurate based on the similar results obtained from the different research results discussed below. Similar results are obtained in the research by Hannaford, et al. (2010) which is almost similar to this particular research in discussion. The results of this research indicate that women who were ever users recorded much lower statistics on the mortality rates and especially when it came to cancers such as ovarian, breast, bowel/ rectum and even uterine among other gynecological cancers. The same lower results were recorded in the circulatory diseases however when it came to violent deaths such as suicide cases, they recorded highly than the never users. These statistics however became similar where the women under 45 years had stopped using the oral contraceptives for periods of between 5 and 9 years as they had almost similar mortality rates with the never users including on cancer deaths. Research conducted by Beaber, et al. (2014) indicated results that were slightly different as it delved deeply into the different types of oral contraceptives such as the one with strong dosage of estrogen, ones with ethynodiol, diacetate as well as the ones with triphasic dosage. According to these results the risk of breast cancer among the ever users of these oral contraceptives also depended on the dosage of the contraceptives one used and their reaction to one’s body. There were reported cases of women being diagnosed with breast cancer despite their lack of usage of the oral contraceptives. General results however were similar with that of the research in discussion that the breast cancer risk increases with the usage of oral contraceptives. The results of this research were similar in statistics with those of the initial research as well as the one by Clark, et al. (2014) showing that those women that were regular users of oral contraceptives reported lower cases of ovarian cancer. The research by Tsilidis, K. et al. (2011) focused more on the violent aspect amongst the ever users and the never users. The results indicated that the women who were ever users of the oral contraceptives were highly prone to violence, intimate partner violence as well as self-inflicted violence than those who were never users. This was attributed to the hormonal changes brought about by the chemical composition in the oral contraceptives. These violent tendencies however may be bound to reduce following to the change in the high hormonal oral contraceptives that have been in use for a long time to much more reduced hormones one as explained in the research by Havrilesky, L. et al. (2013). In all the researches, the studies employed the use of women as the population and this was appropriate because the issue of oral contraceptives, breast and ovarian cancer affected women. In the research by Hannaford, et al. (2010) for example, the population used in the research comprised of46112 women in UK which is a representative figure of the women population in that nation and hence the statistics and the analysis done were appropriate The research by Beaber, et al. (2014) had a population of 21952 and was it was a cohort study paying attention to various variables and hence the statistics were adequate for that role. Research by Tsilidis, K. et al. (2011) was based on the European women in different nations in Europe and had the population of 327, 396 which is relevant considering the number of countries incorporated in the study. In all these researches, the statistics on the never users and the ever users of oral contraceptives specifically that of the number of people dying from the diseases brought about by the oral contraceptives or lack of it is almost similar. Discussion According to the discussion by the authors, the oral contraceptive formulation that was being used by the women during the entire period of the study had higher dosage of hormones and which was causing the accidental and violent deaths as well as the increased risks of breast cancer. Furthermore, the statistics taken 12 years after the research begun were not so different with those of the next 24 years but as the research neared the end, the oral contraceptives used contained lower doses of estrogen than the ones used before and hence the next studies might have different research results than these ones in this research. The discussion further indicated that the reason in some cases there were no significant differences between the ever users and the never users was because the ever users had at some point stopped taking the oral contraceptives for long periods of time hence their bodies reacted the same way to the cancers and the cardiovascular diseases as it did the bodies of the never users. I wholly agree with the discussion provided by the authors on this research because they match the discussions provided by the other authors in the other research studies discussed above. In the research by Beaber, et al. (2014) for example, the women that used the oral contraceptives with high levels of estrogen reported much more elevated risks of developing the breast cancers compared to those who used the oral contraceptives with lower levels of estrogen. Further, the research indicates that women that stopped the usage of the oral contraceptives for a longer period of time tended to have the similar reaction to the never users as the body had reduced protection against the cancers and cardiovascular diseases and hence the likelihood of acquiring these diseases was elevated (Crane, 2011). The other proof to agree with the authors’ discussion is from the research by Clark, et al.(2014) which focuses primarily on the violence from the use and non-use of the oral contraceptives. As the women continued using the hormonal oral contraceptives for longer periods of time, it affected their mental health negatively causing them to commit suicide, get involved in partner violence with their intimate partners and often died as a result of these violence cases as well as other accidents from the hormonal elevation in their bodies. The explanations made by this research study therefore not only proves the discussion by authors to be correct and appropriate but explains in depth the issue of violence and accidental deaths which is not explained in the original article. All the other studies that have been mentioned in detail above tend to have the same discussion and conclusion about their results similar to the discussion made by the authors of this article about the oral contraceptives use on the married nurses between the ages of 30 and 55 years. The general agreement in all these researches is that for the women who engage in regular usage of oral contraceptives, they have a higher chance of getting breast cancer and dying from it as well as engaging in violence and dying from it and accidental deaths than those who do not use the oral contraceptives (Clark, et al.2014). However, they are also in a far better position in relation to avoiding death when it comes to other types of cancers such as ovarian and bowel or colon cancer as well as getting cardiovascular diseases which might increase their death rates as has been explained through research by Havrilesky, et al. (2013). The other researches however such as that by Hannaford, et al. (2010) caution against stopping the usage of these oral contraceptives for long periods of time and especially anywhere between five years and above. This is because the protection the oral contraceptives offer the women’s bodies against the acquisition of the various types of gynecological cancers and heart diseases will reduce as the time elapses. By the end of it all, a woman who was once using the oral contraceptives and then stopped for a very long time suffers the same mortality causes as the one who has never used the oral contraceptives. The researchesTsilidis, K. et al. (2011) also cautions in their discussion against using the oral contraceptives with high hormonal content as it elevates their chances of getting the breast cancer and dying from it quickly. Conclusion The research by Charlton, et al. (2014) discusses the long term effects that the use of oral contraceptives has on married women as well as on those who do not use them. The research results indicate that there is not much difference between the women who use the oral contraceptives and those who do not use it. However, even though the results do not show significant differences in many areas, there are significant differences in as far as cancer acquisition and cardiovascular diseases is concerned. The women who are not regular users or are never users of the oral contraceptives have shown to be diagnosed more and even die more with ovarian cancer as well as cardiovascular diseases compared to the regular users of the oral contraceptives. Caution however is provided in the supporting researches as well as in the discussion section of this research on the differential effects the oral contraceptives with high dosage of hormones has with the lower dosage oral contraceptives which are currently being used by the women in Europe and US where the researches have been based. The briefly mentioned disadvantages of these researchers are that their researchers even though conclusive are not generalizable globally as they have concentrated on the western nations only (Hannaford, et al. 2010). If data was needed about the other continents, new research has to be carried out in these areas as well which is not only expensive but time consuming. Reference Beaber, E., Buist, D., Barlow, W., Malone, K., Reed, S. & Li, C. (2014, August). Recent Oral Contraceptive Use by Formulation and Breast Cancer Risk among Women 20 to 49 Years of Age. The Journal of Cancer Research, 74(15): 4078-4089. Charlton, B., Rich-Edwards, J., Colditz, G., Missmer, S., Rosner, B., Hankinson, S., Speizer, F. & Michels, K. (2014, October). Oral contraceptive use and mortality after 36 years of follow-up in the Nurses’ Health Study: prospective cohort study. BMJ, 349: g6356. Clark, L., Allen, R., Goyal, V., Raker, C. & Gottlieb, A. (2014, January). Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients.American Journal of Obstetrics and Gynecology, 210(1): 42. e1-8. Crane, K. (2011). Oral Contraceptives as Ovarian Cancer Prevention. The Journal of National Cancer Institute, 103(17): 1286-1288. Hannaford, P., Iversen, L., Macfarlane, T., Elliot, A., Angus, V. & Lee, A. (2010, March). Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study.BMJ, 340: c927. Havrilesky, L. et al. (2013, July). Oral contraceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis. Obstetric Gynecology, 122(1): 139- 147. Macera, C., Shaffer, R. & Shaffer, P. (2012). Introduction to Epidemiology: Distribution and Determinants of Disease. New York: Cengage Learning. Tsilidis, K. et al. (2011). Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition. British Journal of Cancer, 105: 1436-1442. Read More