***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To describe attitudes and experiences with a low-dose oral contraceptive pill ( Alesse ) over 3 months , women aged 18 years and older ( n = 218 ) were enrolled from 16 locations to evaluate their experiences with Alesse . The question naire assessed demographic and personal characteristics , attitudes and experiences , and satisfaction . The participants had a mean age of 26.7 years and most were single , Caucasian , had completed high school , had a regular sexual partner , and had previously used OCs . Sixty percent of participants could discuss pill use easily with their mothers , 92 % with friends , and 96 % with partners ; 45 % of the women were unsure about their mother 's previous OC use . Of the 11 side effects assessed , the most frequently anticipated side effect was weight gain . There was a significant relationship between anticipated and reported side effects for weight and mood changes ; however , there remained a number of women for whom these differed . Most ( 90 % ) were satisfied with Alesse . Even when beginning on 20 microg pills , some women may still anticipate side effects such as weight gain typically associated with higher doses of estrogen . Healthcare providers should assess women 's attitudes and anticipated experiences with OCs and counsel accordingly STUDY QUESTION We aim ed to determine the impact of an oral contraceptive ( OC ) treatment on health-related quality of life ( HRQOL ) , depressive and anxiety symptoms in polycystic ovary syndrome ( PCOS ) . SUMMARY ANSWER OC therapy in PCOS improves hirsutism and menstrual disturbances , along with HRQOL . This improvement is not associated with any change in the prevalence of depressive and anxiety symptoms . WHAT IS KNOWN AND WHAT THIS ARTICLE ADDS : Limited data are available regarding the effects of an OC on HRQOL , and depressive and anxiety symptoms in PCOS . This study reports the effects of the ethinyl estradiol/drospirenone ( EE/DRSP ) OC on an HRQOL question naire for women with PCOS ( PCOSQ ) , depressive and anxiety symptoms after 6 months of treatment . DESIGN Prospect i ve observational study . All participants completed PCOSQ , Beck Depression Inventory , Hospital Anxiety and Depression Scale and General Health Question naire . Serum and rogens , fasting insulin , fasting and postload glucose values during an oral glucose tolerance test were measured . Changes in these variables and the scores of question naires were evaluated after 6 months of treatment with EE/DRSP ( 3 mg/30 μg ) . PARTICIPANTS AND SETTING Thirty-six patients with PCOS without a previous psychiatric diagnosis were included in the study . MAIN RESULTS AND THE ROLE OF CHANCE The main complaints of the patients were hirsutism and irregular menses . Accordingly , menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the PCOSQ . Eight patients ( 22.2 % ) had clinical depression scores . After treatment , regular menstrual cycles were attained and hirsutism was significantly improved in all patients . Hirsutism and emotion domains of the PCOSQ improved at 6 months ( P < 0.05 for both ) . Depression was improved in five of eight depressive patients and four new patients showed increased depression scores . Overall , depression , anxiety mean scores and depression rates did not show a significant change . BIAS , CONFOUNDING AND OTHER REASONS FOR CAUTION The study is subject to the strengths and limitations of observational study design . A limitation of our study is the small sample size and lack of data related to possible confounding factors . GENERALIZABILITY TO OTHER POPULATION S Generalizable to Caucasian PCOS The purpose of this study is to examine the association between  oral contraceptive use  ( any current use , duration , and type ) and major depressive disorder ( MDD ) , generalized anxiety disorder ( GAD ) , and panic disorder ( PD ) in a nationally representative sample of women in the USA . Data were drawn from 1,105 women aged 20–39 in the National Health and Nutrition Examination Surveys from 1999 to 2004 . The associations between self-reported use of oral contraceptives in the past year and DSM-IV diagnosed and subthreshold MDD , GAD , and PD in the past year were assessed comparing oral contraceptive users to all non-users , former users , and former long-term users . Women using oral contraceptives had a lower past-year prevalence of all disorders assessed , other than subthreshold MDD . When adjusted for confounders , women using oral contraceptives in the past year had significantly lower odds of subthreshold PD , compared to former users ( odds ratio ( OR ) = 0.34 , 95 % CI 0.14–0.84 ) . Effects estimates were strongest for monophasic ( versus multiphasic ) oral contraceptive users . Hormonal contraceptive use was associated with reduced risk of subthreshold PD . A potential mental health benefit of hormonal contraceptives has substantial public health implication s ; prospect i ve longitudinal studies are needed to confirm whether hormonal contraceptive use improves mental health Abstract Objectives To compare premenstrual and menstrual symptoms in healthy women using nomegestrol acetate/17β-estradiol ( NOMAC/E2 ) and drospirenone/ethinylestradiol ( DRSP/EE ) via the Moos Menstrual Distress Question naire Form C ( MDQ-C ) . Methods Women completed the MDQ-C at baseline and after completion of cycles 1 , 3 , 6 and 13 , for the premenstrual ( four days before most recent flow ) and menstrual ( most recent flow ) phases in two r and omized controlled trials . Treatment effects of NOMAC/E2 and DRSP/EE on the t-scores of eight MDQ-C symptom domains from 3522 women were examined , and the effects of both treatments on the score for cramps from 1779 women with moderate to severe cramps at baseline . Longitudinal data analysis methods were applied in both analyses . Results NOMAC/E2 users experienced a significant improvement in Pain , Water Retention , Negative Affect , Impaired Concentration and Behaviour Change domain scores in the menstrual phase compared with DRSP/EE users ( p < 0.001 for all comparisons ) . However , Arousal ( emotional and mental ) scores worsened with NOMAC/E2 but not with DRSP/EE . Women with moderate to severe cramps experienced an improvement in the cramps score  with NOMAC/E2 and DRSP/EE . Conclusions NOMAC/E2 was effective in reducing most premenstrual and menstrual symptoms , and was associated with significantly greater improvements in many MDQ-C domain scores compared with DRSP/EE . ( Clinical Trials.gov : NCT00413062 and NCT00511199 ) . Chinese Abstract 摘要 目的 通过应用经期不适问卷C表格，调查使用醋酸诺美孕酮/17β雌二醇（NOMAC/E2）和屈螺酮/炔雌醇(DRSP/EE ) 避孕的健康妇女 ， 了解其经前期和经期的不适及改善情况 。 方法 在两个随机对照的临床试验中，受试妇女分别于基线，服药的第1、3、6、13个周期，从月经前期（指月经出血前4天）到月经期（月经出血第一天开始）完成经期不适问卷的C表格。3522名妇女在使用NOMAC/E2和DRSP/EE后，完成经期不适问卷所涉及的八大项相关症状调查。同时对1779名在基线时有中到重度痛经的妇女，对其服药后痛经的改善情况进行评估。在每一项分析中，均采用纵向数据分析法 。 结果 NOMAC/E2使用者在月经期疼痛、水潴留、消极情绪、注意力不集中、行为改变等方面的评分，与DRSP/EE使用者相比较，均有显著的改善（p＜0.001）。然而，NOMAC/E2使用者身心健康感（不论是情绪还是精神）的评分是下降的。对于有着中到重度痛经的妇女，使用NOMAC/E2和DRSP/EE后，其疼痛都是改善的 。 结论 NOMAC/E2对于改善经前期和经期的不适症状都是有效的，与DRSP/EE相比，对经期不适问卷C表格涉及的许多主要症状，均有较大的显著的改善作用 Background : Most women taking combined oral contraceptives ( COCs )  are satisfied with their contraceptive method . However , one of the most common reasons reported for discontinuation of combined oral contraceptives ( COCs ) is mood deterioration . Objectives : This study aim ed to compare effects of the second and third generation oral contraceptive pills on the mood of reproductive women . Material s and Methods : This r and omized , double-blind , controlled clinical trial was conducted in reproductive women at health centers in Tehran , Iran . Participants were r and omized into the second and third generation oral contraceptive groups .  Positive and negative moods were recorded using positive affect , negative affect scale ( PANAS ) tools at the end the second and fourth months of the study . Data analysis was carried out using ANOVA and P Values < 0.05 was considered significant . Results : Statistically significant difference was seen in positive and negative mood changes in women receiving contraceptive pills . The second generation oral contraceptive pills result ed in a decrease in positive mood ( 95 % CI : 43.39 to 38.32 in second month and 43.39 to 26.05 in four month ) and increase in negative mood ( 95 % CI : 14.23 to 22.04 in second month and 14.23 to 32.26 in four month - P < 0.001 ) , but the third generation led to an increase in positive mood ( 95 % CI : 22.42 to 25.60 in second month and 22.42 to 33.87 in four month ) and decrease in negative mood ( 95 % CI : 36.78 to 31.97 in second month and 36.78 to 22.65 in four month - P < 0.001 ) . Conclusions : Third generation combined oral contraceptive pills have a better effect on mood in women in reproductive ages than the second generation pills . It can be recommended as a proper combined oral contraceptive in Iran BACKGROUND Since very little research in this field is available , this study aims to assess the role of psychosexual , relationship , hormonal and genetic measures in the sexual desire of users of three hormonal contraceptive products [ low-dose combined oral contraceptive ( 20 mcg ethinylestradiol/150 mcg desogestrel ) , progestin-only pill ( 75 mcg desogestrel ) and vaginal ring ( daily dose of 15 mcg ethinylestradiol/120 mcg etonogestrel ) ]  . STUDY DESIGN Fifty-five couples were r and omized over three groups in which the women consecutively used each product during 3 months . Both partners repeatedly filled out question naires on solitary and dyadic sexual desire ( desire to behave sexually by oneself or towards a partner ) .  Total and free testosterone , sex hormone binding globulin and a genetic marker of and rogen receptor sensitivity [ cytosine-adenine-guanine ( CAG ) repeat length ] were assessed on blood sample s of the female partners . RESULTS Sexual desire was higher in women with either short or long CAG repeats ( solitary , p=.004 ; dyadic , p=.008 ) . Desire levels were higher during vaginal ring use ( solitary , p=.018 ; dyadic , p=.007 ) . The woman 's mood was found to impact her dyadic sexual desire ( p<.001 ) ; this scale was also strongly associated with the male partner 's dyadic sexual desire ( p<.001 ) . CONCLUSIONS The current study found evidence for a role of and rogen receptor sensitivity and mood in the sexual desire of hormonal contraceptive users The purpose of the study was to explore predictors of discontinuation of oral contraceptives ( OC ) including pre-OC use characteristics and adverse physical , emotional , and sexual effects of OCs . Women aged 18 + years in committed , sexually active relationships were assessed before starting OC and reassessed at 3 , 6 , and 12 months or shortly after discontinuation . Assessment included pre-OC use attitudes and expectations about the pill ; self-reported side effects and perimenstrual symptoms including premenstrual syndrome 
    Output:
    
Common themes that emerge from review of these papers include ( 1 ) most women using CHC demonstrate no effect or a beneficial effect on mood , with a low incidence of adverse effects ; ( 2 ) contraceptives containing less and rogenic progestins may have fewer adverse effects on mood ; ( 3 ) continuous and perhaps non-oral dosing of CHC has the fewest mood effects ; ( 4 ) women with underlying mood disorders may be predisposed to mood effects , but this may reflect factors related to choice of contraception rather than the mood disorder itself .
Inconsistent research methods and lack of uniform assessment s make it difficult to make strong conclusions about which CHC users are at risk for adverse mood effects .