Click here for an explanation of these scores
Answer Rating key
|
search
|
|
strong
|
|
appraisal
|
|
weak
|
|
confidence
|
|
moderate
|
Question answered:26/02/08
Unfortunately, we did not find sufficient information to fully answer this question. However, we did find some information which you may find interesting.
The Faculty of Family Practice and Reproductive Healthcare highlighted a lack of evidence in this area [1], reporting:
“Oral contraception is listed among the recognised trigger factors for EN in all review articles. Evidence for the association comes only from small case series. For example, Salvatore and Lynch reported five cases where EN developed in association with either pregnancy or hormonal contraception. Additional, older literature was not available to the CEU, published evidence did not distinguish between estrogen or non-estrogen containing hormonal contraception.
According to one major review, EN usually resolves spontaneously within six weeks and relapses are exceptional. Serious complications of EN are, reportedly, uncommon.”
And
“The CEU could find no direct evidence on the use of depot medroxyprogesterone acetate (DMPA), the implant or progestogen-only pill (POP) by women with EN. The CEU considers that it is reasonable to prescribe hormonal contraception to women who have had EN, after thorough investigation to exclude a serious underlying cause.”
A 2007 review in the American Family Physician [2] reports:
“Erythema nodosum occurs in up to 4.6 percent of women who are pregnant, possibly as a result of estrogen production or relative levels of estrogen and progesterone. Estrogen also has been proposed as the implicating factor behind the adult male-to-female incidence ratio of 1:6.4 Combination estrogen and progesterone oral contraceptive medications have been associated with erythema nodosum for decades. Hormone therapy also has been implicated. Since the introduction of low-dose oral contraceptives in the 1980s, the number of oral contraceptive-related cases of erythema nodosum has decreased. This decline may be a result of current at-or-below physiologic levels of 20 to 50 mcg ethinyl estradiol in oral contraceptives, although a well-defined association between estrogen and erythema nodosum has not been established. Furthermore, there have been no reported cases of estrogen-secreting obstetric malignancies causing erythema nodosum. The relative concentration of estrogen and progesterone in oral contraceptives and hormone therapy as well as during pregnancy may be more directly associated with erythema nodosum than estrogen levels alone.”
References
1) http://www.ffprhc.org.uk/admin/uploads/No1951.pdf
2) http://www.aafp.org/afp/20070301/695.html
DISCLAIMER: TRIPanswers is a collection of clinical questions and answers. Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document. Also, ensure you have read the terms and conditions for using the site.