University of Arkansas, Fayetteville ScholarWorks@UARK Health, Human Performance and Recreation Health, Human Performance and Recreation Undergraduate Honors Theses 5-2019 Sex-hormone fluctuations and their effects on sexual function in IUS users Kaley Ferguson Follow this and additional works at: https://scholarworks.uark.edu/hhpruht Part of the Medicine and Health Sciences Commons Recommended Citation Ferguson, Kaley, "Sex-hormone fluctuations and their effects on sexual function in IUS users" (2019). Health, Human Performance and Recreation Undergraduate Honors Theses. 73. https://scholarworks.uark.edu/hhpruht/73 This Thesis is brought to you for free and open access by the Health, Human Performance and Recreation at ScholarWorks@UARK. It has been accepted for inclusion in Health, Human Performance and Recreation Undergraduate Honors Theses by an authorized administrator of ScholarWorks@UARK. For more information, please contact [email protected]. Running head: SEX-HORMONE FLUCTUATIONS AND THEIR EFFECTS 1 Sex-hormone fluctuations and their effects on sexual function in IUS users A thesis submitted in partial fulfillment of the requirements for the degree of Bachelor of Science of Public Health by Kaley Ferguson Graduation May 2019 University of Arkansas SEX-HORMONE FLUCTUATIONS AND THEIR EFFECTS 2 Introduction Unintended pregnancy affects many women’s quality of life. Data suggest that unplanned pregnancies are a result of incorrect, inconsistent, or nonuse use of an effective contraceptive method (Smith, Jozkowski, & Sanders, 2014). A highly effective option for contraception is an intrauterine device, or IUD. The IUD is touted, by physicians and researchers alike, as one of the most effective methods for preventing pregnancy (AGOG). They are reversible, long-acting, and are increasingly considered a contraceptive method that can help lower the extremely high rate of unintended pregnancy in the United States which is currently hovering just below 50% (Finer & Zolna, 2011). IUDs are a part of a group of contraceptive methods called LARCs or long-acting reversible contraception. A specific type of IUD that functions on a hormonal mechanism are called intrauterine systems or IUSs. LARCs are widely considered to be the most effective reversible contraceptive methods and include IUDs and the subdermal implant. LARC methods have been shown to have method failure rates close to tubal sterilization. IUDs have failure rates that are more in line with perfect use failure rates than with rates that account for human error (Stoddard, McNicholas, & Peipert, 2011). Unfortunately, few women in the United States are using IUDs (Stoddard, McNicholas, & Peipert, 2011). Despite being suggested as a first-line contraceptive method for women and adolescents (ACOG), only 5.5% of women in the United States who use contraceptives rely on IUDs as their primary method. This low rate is shocking when compared to the rest of the world where countries such as Norway and China have rates as high as 27% and 30% respectively (Gomez & Clark, 2014; Stoddard et al., 2011). When asked in 2002, as much as 39% of women in the United States reported not knowing anything about IUDs (Gomez & Clark, 2014; Stoddard et al., 2011). Because the United States is a nation with an extremely high incidence of unintended pregnancy, the lack of understanding regarding one of SEX-HORMONE FLUCTUATIONS AND THEIR EFFECTS 3 the most effective forms of birth control is unsettling. The low use of IUDs in the United States can most likely be attributed to a lack of trained providers, high initial cost, and inaccurate knowledge both among clinicians and patients (Stoddard, McNicholas, & Peipert, 2011). According to Smith and colleagues (2014), “identifying the factors that may contribute to women’s nonuse or inconsistent use of hormonal contraception is extremely important for the continued promotion of planned and timed pregnancies in the United States” (p. 469). One of the major factors that may contribute to nonuse, inconsistent use, or discontinuation of a method are the method’s effects on sexual function. Women have reported that hormonal fluctuations and effects on sexual function as contributing factors to inconsistent or nonuse of a method (Sanders, Graham, Bass, Bancroft, 2001). There exists a plethora of literature on the effects of oral contraceptive pills (OCPs) on hormones and sexual function, but there is not a comparable amount of data on the effects of IUDs on the same parameters. The gap in the literature leads to the question: what is the effect of hormonal IUDs on hormone fluctuations and sexual function? Answering the above question is imperative to improving knowledge around IUD usage. In order to reduce the number of unplanned pregnancies, strategies to improve consistent use of contraception by young women and teenagers must be determined. Because women who had heard about the IUD from a healthcare provider were 2.7 times more likely to be interested in using the method, enhancing knowledge and determining a strategy to improve consistent contraceptive use are linked (Fleming, Sokoloff, & Raine 2010). Clinicians should be knowledgeable about IUDs and encouraged to talk to women about them. To promote IUD use through conversation, providers must fully understand the side effects of IUDs including their effects on hormones and sexual function. SEX-HORMONE FLUCTUATIONS AND THEIR EFFECTS 4 Literature Review Unintended pregnancy and effective contraceptive methods to help women prevent pregnancy have be prevalent topics in public health literature. As such, a plethora of research has been established to determine the most effective methods of preventing pregnancy. Within the current literature, IUDs provide a notable contrast to most other reversible contraceptive methods such as the oral contraceptive pill (OCP) because they are more effective. Unlike OCPs, IUDs present no risk of failure due to error, poor adherence, or noncompliance (Anderson et al. 2014). As such, IUDs have efficacy rates close to those of tubal sterilization at less than 1%, while typical oral contraceptive efficacy rate is 8-9% (Stoddard, McNicholas, & Peipert, 2011). No attention is required on the part of an IUD user after insertion until time for removal, making IUDs a significantly more effective method than OCPs when considering user error. Despite their efficacy, very few women in the United States use IUDs as their primary method of contraception. Rates for IUD usage among women in the United States who are practicing birth control hover around 5.5% (Stoddard, McNicholas, & Peipert, 2011). The low rate of IUD use in the United States is likely related to a number of factors; however, the most notable is lack of provider knowledge (Anderson et al. 2014). Because very little information exists on the effects of hormonal IUDs on sex-hormone levels and the subsequent effects on sexual function, providers cannot have appropriate conversations with women regarding IUDs and their sexual health. Lack of provider knowledge regarding IUDs and sexual function is important because sexual function is a primary reason that many women discontinue a contraceptive method. Sanders et al. (2014) found that, in a cohort of women using oral contraceptive pills, 8% of women who discontinued or switched pills did so because of sexual side effects. Women who are using or may be interested in using IUDs will have questions about potential sexual side effects that the devices may have. Additionally, women are more likely to SEX-HORMONE FLUCTUATIONS AND THEIR EFFECTS 5 consider using an IUD if they hear about the method from their providers (Fleming, Sokoloff, & Raine 2010). Studies also indicate that providers who have access to more evidence-based information are significantly more likely to offer information about IUDs to their patients (Fleming, Sokoloff, & Raine 2010), demonstrating that providers need to be equipped with the knowledge to initiate conversations about IUDs; properly answer their patients’ questions about IUDs, hormones, and sexual function; and address their patients’ concerns regarding IUDs. Although there is a lack of research surrounding hormonal IUDs, sex-hormone levels, and sexual function, there is a large amount of data covering oral contraceptive methods and their effects on hormones and sexual function. Understandably, more research has been done on hormone levels and sexual function in women taking oral contraceptives. Oral contraceptives are the most popular form of reversible contraception used in the United States with approximately 80% of women using oral contraceptives at some point in their lifetimes (Rosenberg, Waugh, 1998). However, because compliance is a major contributor to the lower effectiveness rate of oral contraceptives, more research should be done to level the playing field in the literature between IUDs and OCPs to equip clinicians and public health workers with the proper knowledge and abilities to properly address unintended pregnancy. Given their hormonal nature, it is understandable that many researchers questioned, early on, the effects that oral contraceptives would have on hormones. In general, combined oral contraceptives decrease ovarian production of testosterone (Burrows, Basha, Goldstein 2012). because they inhibit luteinizing hormone (LH). The estrogen component of combined oral contraceptives leads to an increased production on sex hormone binding globulin (SHBG) which in turn decreases free testosterone and other androgens (Burrows, Basha,