Haematologic and haemostatic changes in women on hormonal contraceptives in Lagos

Abstract

Several attempts are made to increase hormonal contraceptive usage in Nigerian women. This study aimed to determine the haematological and haemostatic parameters of reproductive-age women on hormonal contraceptives at the Family Health Clinic of Lagos University Teaching Hospital and Planned Parenthood Federation of Nigeria, Lagos. A comparative cross-sectional study was conducted amongst 88 participants recruited using a consecutive sampling technique. Sociodemographic data were collected through face-to-face interviews with the use of a structured questionnaire. Three and half millilitres of venous blood was collected for full blood count estimation and 4.5ml for tests of haemostasis (PT, APTT, TT, D-dimer, Protein C) from each participant. Data was analysed using Statistical Package for Social Science (SPSS) version 22 as well as Microsoft Excel. Test for normal distribution was done using histogram, box plot, and Kolmogorov-smirnov. Mean difference in values for numerical variables was computed using Mann-Whitney U test statistics while median value was reported as measures of central tendency. A p-value of <0.05 was considered significant in all statistical comparison. Fifty of the evaluated women were on different forms of hormonal contraceptives with the remaining 38 serving as controls. Among those on contraceptives, 10% were on combined (oestrogen and progestogen) oral pill, 40% were on implant progestogen only and 50% were on injectable progestogen only contraceptives. Results from all contraceptive users show significantly higher median values of prothrombin time (PT) and D-Dimer compared to control groups. (P=0.000, P=0.02 respectively) Thirty eight percent of study participants who were on contraceptives (both combined oral pill, implant progestogen only or injectable progestogen only) for less than a year had statistically higher median PT and D- Dimer compared to controls (p= 0.001, p=0.03 respectively) while 62 percent (31) of participants on HC (both combined oral pill, implant progestogen only or injectable progestogen only) for greater than 1year had statistically higher median PT and mean platelet volume compared to controls (p= 0.000, p=0.04 respectively) There were no statistically significant differences between the values of haematological parameters. Haemostatic parameters (TT, APTT and protein C) of women on hormonal contraceptives also did not show significant differences except in PT and D-dimer which suggests an attempt to balance thrombotic and fibrinolytic effects of hormonal contraceptives in-vivo. The risk of thrombosis in women on hormonal contraceptives is reduced with increased fibrinolytic activity in-vivo. However, it is recommended that prescribers of hormonal contraceptives ensure baseline haematologic tests are conducted before commencing the use, weigh the risk/benefit ratio and ensure continuous monitoring of users.