Background: In female patients with cystic fibrosis (CF), female sex predisposes to the progression and worsening of lung function, which increases the incidence of acute exacerbations, and leads to the earlier bacterial colonization of Pseudomonas aeruginosa. The negative effect of estrogens on the clinical course of CF in girls begins to manifest with the onset of puberty and the appearance of secondary sexual characteristics. On the cellular-level estrogens affect: 1.) immune and anti-inflammatory processes (reduced lactoferrin production, decreased response of IL-8), 2.) microbial spectrum - the early colonization of Ps. aeruginosa and its faster conversion to the mucous strain; and 3.) mucociliary clearance - estrogens lead to dehydration of the mucus layer by increasing the sodium channels expression and by reducing the activity of the calcium-activated chloride channels. During the phase of the menstrual cycle with the highest concentration of estrogens, the mucociliary transport is impaired, and thus airway cleansing, which predisposes to acute exacerbation of the pulmonary infection. Adult women with CF receiving hormonal contraceptives have shown significantly lower estradiol concentrations associated with reduced incidence of acute exacerbations and decreased consumption of antibiotics.
Case report: Authors present a case study of a 15-year-old patient with CF diagnosed in the neonatal period with a relatively favorable course of the disease. With the onset of menarche, there have been repeated acute exacerbations of pulmonary infection with altered clinical status. After the fifth bronchopneumonia, a low-dose hormonal contraceptive was given, which significantly reduced the incidence of exacerbations of pulmonary infection. We have not experienced any undesirable effects during continuous hormonal contraception.
Conclusion: The use of hormonal contraceptives in the light of the latest findings has been shown to be a promising way to influence the incidence of exacerbations of lung infections and to improve the prognosis of patients with CF.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology