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Brynhildsen, Jan
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Publications (10 of 54) Show all publications
Malmborg, A., Brynhildsen, J. & Hammar, M. (2019). A survey of young womens perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire. Sexual & Reproductive HealthCare, 21, 75-80
Open this publication in new window or tab >>A survey of young womens perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Objectives: Few studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. Study design: A secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. Main outcome measures: Were self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. Results: A negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p amp;lt; 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8-13.8). The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1-11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2-6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). Conclusions: The women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Contraception; Intrauterine contraceptives; Lng-IUS; Cu IUD; Sexual desire; Sexual function
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-161009 (URN)10.1016/j.srhc.2019.06.007 (DOI)000485335500013 ()31395237 (PubMedID)
Note

Funding Agencies|Region of Ostergotland

Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2020-01-15
Lundin, C., Gemzell Danielsson, K., Bixo, M., Moby, L., Bengtsdotter, H., Jawad, I., . . . Sundstrom Poromaa, I. (2017). Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology, 76, 135-143
Open this publication in new window or tab >>Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial
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2017 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 76, p. 135-143Article in journal (Refereed) Published
Abstract [en]

Objective: Ever since the introduction of combined oral contraception (COC), one of the major reasons for discontinuing the pill use has been mood-related side effects. Moreover, women who discontinue the pill turn to less effective methods whereby the probability of an unintended conception increases. Approximately 4-10% of COC users complain of depressed mood, irritability or increased anxiety, but drug-related causality has been difficult to prove. Given the lack of randomized controlled trials in this area, we aimed to prospectively estimate the severity of adverse mood in COC users that would be as representative of general users as possible. Methods: This investigator-initiated, multi-center, randomized, double-blinded, placebo-controlled study included 202 healthy women. Women were randomized to a COC (1.5 mg estradiol and 2.5 mg nomegestrolacetate) or placebo for three treatment cycles. Main outcome measure was the Daily Record of Severity of Problems (DRSP), which was filled out daily during one baseline cycle and the final treatment cycle. Results: Results from 84 women in the COC group and 94 women in the placebo group were analysed. COC use was associated with small, but statistically significant, increases in mean anxiety (0.22; 95% CI: 0.07-0.37, p = 0.003), irritability (0.23; 95% CI: 0.07-0.38, p = 0.012), and mood swings scores (0.15; 95% CI: 0.00-0.31, p = 0.047) during the intermenstrual phase, but a significant premenstrual improvement in depression (-0.33; 95% CI: -0.62 to -0.05, p = 0.049). Secondary analyses showed that women with previous adverse hormonal contraceptive experience reported significantly greater mood worsening in the intermenstrual phase in comparison with healthy women, p amp;lt;0.05. The proportion of women who reported a clinically relevant mood deterioration did not differ between those allocated to COC (24.1%) or placebo (17.0%), p = 0.262. Conclusion: COC use is associated with small but statistically significant mood side effects in the inter menstrual phase. These findings are driven by a subgroup of women who clearly suffer from COC-related side effects. However, positive mood effects are noted in the premenstrual phase and the proportion of women with clinically relevant mood worsening did not differ between treatment groups. (C) 2016 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2017
Keywords
Randomized clinical trial; Combined oral contraceptives; Estrogen; Progestagen; Depression; Anxiety; Irritability
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-135395 (URN)10.1016/j.psyneuen.2016.11.033 (DOI)000393723600019 ()27923181 (PubMedID)
Note

Funding Agencies|Swedish Research Council [K2013-99X-22269-01-3]

Available from: 2017-03-14 Created: 2017-03-14 Last updated: 2018-05-02
Malmborg, A., Persson, E., Brynhildsen, J. & Hammar, M. (2016). Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women. European journal of contraception & reproductive health care, 21(2), 158-167
Open this publication in new window or tab >>Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women
2016 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 21, no 2, p. 158-167Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of the study was to determine whether a decrease in sexual desire is more prevalent among women using hormonal contraception than among women using hormone-free contraception, and whether a decrease increases the risk of changing to another contraceptive method. Methods A validated questionnaire was posted to 3740 women (aged 22, 25 or 28 years) living in Sweden. Descriptive statistics were used to present the results; differences between groups were tested using χ(2) analyses. A multiple logistic regression model was used for analysis of possible confounders. Results The response rate was 50%. The majority (81%) of respondents used some kind of contraception, and 88% were generally satisfied with the method used. Regardless of the type of method, 27% of hormonal contraceptive users reported a decrease in sexual desire that they attributed to their use of hormonal contraception, whereas only 12% of women using hormone-free contraception reported a decrease in sexual desire (p<0.01). This twofold risk of a decrease in sexual desire was shown in the multiple regression analysis to be independent of age group, depression, BMI, educational level and parity. However, having a partner was found to be a factor of equal importance: women with partners experienced reduced desire twice as often as women without partners. The observed odds ratio for planning to stop hormonal contraception or to change to a different type due to reduced desire was 8.16 (95% confidence interval 6.65-10.1) among women who had had the same experience during a previous period of hormonal contraceptive use. Conclusions Women using hormonal contraception were more likely to experience reduced sexual desire compared with women using hormone-free contraception. Experiencing reduced desire was a strong predictive factor for women to change contraceptive method.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016
Keywords
Cross-sectional study; Hormonal contraceptives; Intrauterine devices; Progestin; Sexual desire
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-126286 (URN)10.3109/13625187.2015.1079609 (DOI)000375025700007 ()26406399 (PubMedID)
Available from: 2016-03-22 Created: 2016-03-21 Last updated: 2019-11-05
Kilander, H., Alehagen, S., Svedlund, L., Westlund, K., Thor, J. & Brynhildsen, J. (2016). Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study. Acta Obstetricia et Gynecologica Scandinavica, 95(5), 565-571
Open this publication in new window or tab >>Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study
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2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 5, p. 565-571Article in journal (Refereed) Published
Abstract [en]

IntroductionDespite high access to contraceptive services, 42% of the women who seek an abortion in Sweden have a history of previous abortion(s). The reasons for this high repeat abortion rate remain obscure. The objective of this study was to study the choice of contraceptive method after abortion and related odds of repeat abortions within 3-4 years. Material and methodsThis is a retrospective cohort study based on a medical record review at three hospitals in Sweden. We included 987 women who had an abortion during 2009. We reviewed medical records from the date of the index abortion until the end of 2012 to establish the choice of contraception following the index abortion and the occurrence of repeat abortions. We calculated odds ratios (OR) with 95% CI. ResultsWhile 46% of the women chose oral contraceptives, 34% chose long-acting reversible contraceptives (LARC). LARC was chosen more commonly by women with a previous pregnancy, childbirth and/or abortion. During the follow-up period, 24% of the study population requested one or more repeat abortion(s). Choosing LARC at the time of the index abortion was associated with fewer repeat abortions compared with choosing oral contraceptives (13% vs. 26%, OR 0.36; 95% CI 0.24-0.52). Subdermal implant was as effective as intrauterine device in preventing repeat abortions beyond 3 years. ConclusionsChoosing LARC was associated with fewer repeat abortions over more than 3 years of follow up.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
Long-acting reversible contraception; post-abortion contraception; repeat abortion; subdermal implant; termination of pregnancy
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-128136 (URN)10.1111/aogs.12874 (DOI)000374349400012 ()26871269 (PubMedID)
Note

Funding Agencies|Futurum - the academy for healthcare; Jonkoping County Council; Medical Research Council of Southeast Sweden (FORSS)

Available from: 2016-05-19 Created: 2016-05-19 Last updated: 2018-11-26
Ginstman, C., Frisk, J., Ottosson, J. & Brynhildsen, J. (2015). Contraceptive Use Before and After Gastric Bypass: a Questionnaire Study. Obesity Surgery, 25(11), 2066-2070
Open this publication in new window or tab >>Contraceptive Use Before and After Gastric Bypass: a Questionnaire Study
2015 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 25, no 11, p. 2066-2070Article in journal (Refereed) Published
Abstract [en]

At present, women are recommended to avoid pregnancy 12-18 months after bariatric surgery. Our aim in this study was to describe patterns of contraceptive use before and after gastric bypass in Sweden, and to describe the contraceptive counseling given preoperatively to women undergoing gastric bypass. In October 2012, a questionnaire was sent to 1000 Swedish women who all had undergone gastric bypass during 2010. The women had been included in the Scandinavian Obesity Surgery Register at time of surgery. The main outcome measures were patterns of use of contraception before and after bariatric surgery. The response rate was 57 %. The most commonly used contraceptive methods were intrauterine devices, 29 % preoperatively and 26 % postoperatively even though there was a postoperative switch from the copper intrauterine device to the levonorgestrel intrauterine system. Thirty percent did not use any contraceptive during the first 12 months after surgery. Sixty percent of the responders were aware of the recommendations to avoid pregnancy after surgery. Many women who undergo bariatric surgery are not using any contraceptive method despite the recommendation that they should avoid pregnancy for at least 12 months. There is a great need to improve contraceptive counseling for this growing group of women.

Place, publisher, year, edition, pages
SPRINGER, 2015
Keywords
Gastric bypass; Pregnancy; Contraception; Obesity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-122518 (URN)10.1007/s11695-015-1641-7 (DOI)000362578700048 ()25744304 (PubMedID)
Note

Funding Agencies|Bayer AB, Sweden

Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2019-05-02
Palmquist, M., Brynhildsen, J. & Falk, G. (2015). Organisation of contraceptive care and attitudes among healthcare providers in two Swedish cities with different socio-demographic profiles. European journal of contraception & reproductive health care, 20(3), 170-180
Open this publication in new window or tab >>Organisation of contraceptive care and attitudes among healthcare providers in two Swedish cities with different socio-demographic profiles
2015 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 3, p. 170-180Article in journal (Refereed) Published
Abstract [en]

Objective To compare contraceptive services provided by family planning clinics in Linkoping and Norrkoping in Ostergotland County, Sweden. The two cities are of similar size but have different socio-demographic profiles. The abortion rate in Link ping (15.3 per 1000) is substantially lower than in Norrkoping (21.1 per 1000). Methods The study was performed in two steps. First, the clinics providing contraceptive services in the two cities were studied using ten pre-defined quality indicators. Thereafter, 11 healthcare providers were interviewed: six in Linkoping and five in Norrkoping. The interviews were analysed using qualitative content analysis. Results No differences were found in the organisation of contraceptive care in the two cities. Neither city met the criteria for five of the ten quality indicators. The analysis of the interviews generated four themes: Guidelines and electronic record template, Criteria for good contraceptive counselling, Availability of contraception, and Sexual health. The interviews revealed that the clinical leadership in Norrkoping was insuffincient. Conclusion Clinics in the two cities are organised in the same way so that differences in abortion rates cannot be related to differences in organisation. The reasons for the differences in abortion rates in the two cities have yet to be determined.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
Quality indicators; Contraceptive care; Socio-economic structure; Abortion; Content analysis
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120059 (URN)10.3109/13625187.2014.976195 (DOI)000355981900003 ()25428331 (PubMedID)
Note

Funding Agencies|ALF grants, County Council of Ostergotland

Available from: 2015-07-06 Created: 2015-07-06 Last updated: 2017-12-04
Kempe, P., Hammar, M. & Brynhildsen, J. (2015). Symptoms of Multiple Sclerosis during use of Combined Hormonal Contraception. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 193
Open this publication in new window or tab >>Symptoms of Multiple Sclerosis during use of Combined Hormonal Contraception
2015 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 193Article in journal (Refereed) Published
Abstract [en]

Objective: Incidence and disease course of Multiple Sclerosis (MS) is influenced by sex steroids and several studies have shown less disease activity during high estrogen states. We have earlier shown variation in symptom experience related to estrogen/progestogen phase in women using combined hormonal contraceptives (CHC) in a small sample. The aim of this study was confirm these results in a larger sample.

Design: Self-assessment of symptoms of MS in relation to CHC cycle or menstrual cycle. Sample: Twenty-three female MS patients using CHC. Control groups were female MS patients without hormonal contraception and healthy women with CHC and without hormonal contraception.

Methods: All women filled out a symptom diary based on a validated instrument for cyclical symptoms.

Main Outcome measures: Mean scores for high and low estrogen/progestogen phases were compared.

Results: The women with MS using combined hormonal contraceptives scored all symptoms higher during the pill-free week than during the CHC-phase and the scores for vertigo, weakness, urinary symptoms and stiffness were significantly higher during the seven days without CHC (p < 0.05). No such relation was found in the group of women with MS not using any hormonal contraception. Women without MS did not report any symptoms at all.

Conclusion: Women with MS report more pronounced symptoms during the lowestrogen/ progestogen phase of CHC use. Future studies should investigate, with a prospective, controlled design, which effects continuous-use regimens of CHC have in women with MS.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Multiple Sclerosis, Combined Hormonal Contraceptives, Symptom experience
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-108886 (URN)10.1016/j.ejogrb.2015.06.030 (DOI)000361777400001 ()
Note

Funding: County Council of Ostergotland, Sweden; County Council of Vasternorrland, Sweden

Available from: 2014-07-10 Created: 2014-07-10 Last updated: 2017-12-05Bibliographically approved
Kopp Kallner, H., Thunell, L., Brynhildsen, J., Lindeberg, M. & Gemzell Danielsson, K. (2015). Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey. PLoS ONE, 10(5), e0125990
Open this publication in new window or tab >>Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women - A Nationwide Survey
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, p. e0125990-Article in journal (Refereed) Published
Abstract [en]

Objective To describe contraceptive use and attitudes towards contraceptive use in Sweden which has the highest abortion rate in Western Europe. Secondary objectives were to investigate knowledge of contraceptive methods and outcomes of unplanned and unwanted pregnancies. Design Telephone survey. Setting National survey of women living in Sweden. Population Women between 16 and 49 years. Methods The survey contained 22 questions with free text and multi choice answers on demographics, contraceptive use, knowledge of and attitudes towards contraception, the importance of monthly bleeding and experience of unintended pregnancy. Main Outcome Measures Distribution of use of contraceptive methods and non-use of contraception among Swedish women. Prevalence and outcome of unintended pregnancies. Results A total of 1001 women participated in the survey. Of all women, 721/1001 (72.1%) currently used contraception whereas 268/1001 (26.8%) women did not. Long acting reversible contraception, (LARC; implant and intra uterine contraception) was used by 24.3% of women. The unmet need of contraception in Sweden was estimated at 8.9% (89/1001 women). A total of 781 (78%) women had never experienced an unintended pregnancy whereas 220 (22%) women had had at least one unintended pregnancy. Users and non-users alike stated that one of the most important characteristics of a contraceptive method is its effectiveness. Conclusions Sweden has a large unmet need for contraception. Furthermore, a large proportion of women have experienced at least one unintended pregnancy. Increasing contraceptive use and promotion of LARC is a possible way forward in the effort to reduce the rates of unwanted pregnancies.

Place, publisher, year, edition, pages
Public Library of Science, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-119251 (URN)10.1371/journal.pone.0125990 (DOI)000354921400051 ()25992901 (PubMedID)
Note

Funding Agencies|MSD Sweden

Available from: 2015-06-12 Created: 2015-06-12 Last updated: 2017-12-04
Kjölhede, P., Persson, P. & Brynhildsen, J. (2014). Authors' reply: Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study [Letter to the editor]. British Journal of Obstetrics and Gynecology, 121(12), 1579-1579
Open this publication in new window or tab >>Authors' reply: Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study
2014 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, no 12, p. 1579-1579Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112618 (URN)10.1111/1471-0528.12701 (DOI)000344372600032 ()25348452 (PubMedID)
Available from: 2014-12-08 Created: 2014-12-05 Last updated: 2019-06-28Bibliographically approved
Berin, E., Sundell, m., Karki, C., Brynhildsen, J. & Hammar, M. (2014). Contraceptive knowledge and attitudes among women seeking induced abortion in Kathmandu, Nepal. International Journal of Women's Health, 6(1), 335-341
Open this publication in new window or tab >>Contraceptive knowledge and attitudes among women seeking induced abortion in Kathmandu, Nepal
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2014 (English)In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 6, no 1, p. 335-341Article in journal (Refereed) Published
Abstract [en]

Objective: To map the knowledge about and attitudes toward birth control methods among women in Kathmandu, Nepal, and to compare the results between women seeking an induced abortion and a control group. Method: This was a cross-sectional cohort study with matched controls. Women aged 15-49 years seeking medical care at the Department of Gynecology and Obstetrics at Kathmandu Medical College were included and interviewed. A case was defined as a woman who sought an elective medical or surgical abortion. A control was defined as a woman who sought medical care at the outpatient department or had already been admitted to the ward for reasons other than elective abortion. A questionnaire developed for the study - dealing with different demographic characteristics as well as knowledge about and attitudes toward contraceptives - was filled out based on the interview. Results: A total of 153 women were included: 64 women seeking an abortion and 89 controls. Women seeking an abortion had been pregnant more times than the control group and were more likely to have been informed about contraceptives. Women with higher education were less likely to seek an abortion than women with lower education. There was no significant difference in knowledge about and attitudes toward contraceptives between cases and controls. The women considered highest possible effectiveness to be the most important feature when deciding on a birth control method. Conclusion: Women seeking abortion in Kathmandu had shorter education and a history of more pregnancies and deliveries than women in the control group. Education and counseling on sex and reproduction as well as on contraceptive methods probably need to be improved in Nepal to avoid unwanted pregnancies. Attitudes about contraceptives need to be further investigated to develop better and more effective methods to educate women about family planning in order to increase reproductive health. © 2014 Berin et al.

Place, publisher, year, edition, pages
Dove Medical Press, 2014
Keywords
Abortion; Contraceptive knowledge; Family planning; Nepal
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-116403 (URN)10.2147/IJWH.S57370 (DOI)24672261 (PubMedID)2-s2.0-84897825359 (Scopus ID)
Available from: 2015-03-27 Created: 2015-03-26 Last updated: 2017-12-04
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