THE IMPACT OF HORMONAL CONTRACEPTIVES ON IRON (FE) STATUS IN WOMEN OF REPRODUCTIVE AGE
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Objective: This study aims to assess the impact of hormonal contraceptive use on Fe status among a cohort of reproductive-aged females. Design: Cross-sectional analysis of data from the FeGenes study. Subjects: The research participants (n = 255) were healthy, non-pregnant, and non-lactating premenopausal females between the ages of 18 and 50 years, without obesity or chronic diseases, recruited from the Iron Genes in East Asians and Northern Europeans Study (FeGenes) cohort (n = 504). All females were of genetically confirmed Northern European (n=128) or East Asian ancestry (n=127). Intervention or Exposure: Participants were stratified into two groups: Hormonal Contraceptive users (HC, n = 71) or Non-Hormonal Contraceptive users (NHC, n = 184 defined as those who reported using non-hormonal contraceptives, unspecified contraceptives, or no contraceptive use). For additional analyses, participants were further stratified into three groups based on hormone type: Combined estrogen and progestin-containing Hormonal Contraceptives (Combined-HC, n = 35), Progestin-only Hormonal Contraceptives (Progestin-HC, n = 31), or No Hormonal Contraceptives (NHC, n =184). Main Outcome Measures: Fe status and inflammatory biomarkers (serum ferritin, CRP, hepcidin, soluble transferrin receptor (sTfR), and transferrin (Tf)) were measured using immunoassays, with data presented as geometric means or means ± SD. Statistical analyses included adjustments for ancestry group, BMI, and age. Results: No differences in iron deficiency (ID), iron deficiency anemia (IDA), or prevalence of anemia were noted between individuals who did or did not use HC. Serum CRP and Tf concentrations were significantly higher in the HC compared to NHC group (p < 0.001 and p < 0.001, respectively). Additional analyses were conducted to determine whether differences in CRP and Tf observed varied by hormone type. Combined-HC users had significantly higher Tf and CRP (p < 0.0001, p < 0.001, respectively) compared to the Progestin-HC and NHC groups. Conclusion: Given the variable hormonal content and composition of current hormonal contraceptives, more work is needed to understand the impact of specific hormonal contraceptive exposures on menstrual blood losses and iron status in reproductive-aged women.