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Moby, Lena
Publications (9 of 9) Show all publications
Engman, J., Sundström Poromaa, I., Moby, L., Wikström, J., Fredriksson, M. & Gingnell, M. (2018). Hormonal Cycle and Contraceptive Effects on Amygdala and Salience Resting-State Networks in Women with Previous Affective Side Effects on the Pill.. Neuropsychopharmacology, 43(3), 555-563
Open this publication in new window or tab >>Hormonal Cycle and Contraceptive Effects on Amygdala and Salience Resting-State Networks in Women with Previous Affective Side Effects on the Pill.
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2018 (English)In: Neuropsychopharmacology, ISSN 0893-133X, E-ISSN 1740-634X, Vol. 43, no 3, p. 555-563Article in journal (Refereed) Published
Abstract [en]

The mechanisms linking ovarian hormones to negative affect are poorly characterized, but important clues may come from the examination of the brain's intrinsic organization. Here, we studied the effects of both the menstrual cycle and oral contraceptives (OCs) on amygdala and salience network resting-state functional connectivity using a double-blind, randomized, and placebo-controlled design. Hormone levels, depressive symptoms, and resting-state functional connectivity were measured in 35 healthy women (24.9±4.2 years) who had previously experienced OC-related negative affect. All participants were examined in the follicular phase of a baseline cycle and in the third week of the subsequent cycle during treatment with either a combined OC (30 μg ethinyl estradiol/0.15 mg levonorgestrel) or placebo. The latter time point targeted the midluteal phase in placebo users and steady-state ethinyl estradiol and levonorgestrel concentrations in OC users. Amygdala and salience network connectivity generally increased with both higher endogenous and synthetic hormone levels, although amygdala-parietal cortical connectivity decreased in OC users. When in the luteal phase, the naturally cycling placebo users demonstrated higher connectivity in both networks compared with the women receiving OCs. Our results support a causal link between the exogenous administration of synthetic hormones and amygdala and salience network connectivity. Furthermore, they suggest a similar, potentially stronger, association between the natural hormonal variations across the menstrual cycle and intrinsic network connectivity.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333689 (URN)10.1038/npp.2017.157 (DOI)000419961500011 ()28741624 (PubMedID)
Funder
Swedish Research Council, 2016-01439Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955, 2007-2116
Available from: 2017-11-16 Created: 2017-11-16 Last updated: 2018-02-14Bibliographically approved
Lundin, C., Danielsson, K. G., Bixo, M., Moby, L., Bengtsdotter, H., Jawad, I., . . . Poromaa, I. S. (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 <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.

Keywords
Randomized clinical trial, Combined oral contraceptives, Estrogen, Progestagen, Depression, Anxiety, Irritability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-317606 (URN)10.1016/j.psyneuen.2016.11.033 (DOI)000393723600019 ()27923181 (PubMedID)
Funder
Swedish Research Council, K2013-99X-22269-01-3
Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2017-11-29Bibliographically approved
Gingnell, M., Bannbers, E., Engman, J., Frick, A., Moby, L., Wikström, J. & Sundström-Poromaa, I. (2016). The effect of combined hormonal contraceptives use on brain reactivity during response inhibition. European journal of contraception & reproductive health care, 21(2), 150-157
Open this publication in new window or tab >>The effect of combined hormonal contraceptives use on brain reactivity during response inhibition
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2016 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 21, no 2, p. 150-157Article in journal (Refereed) Published
Abstract [en]

Objectives Cognitive control, which can be described as the ability to moderate impulses, has not previously been investigated in users of combined hormonal contraception (CHC). Given the suggested modulatory role of ovarian steroids in prefrontal dopaminergic function, which in turn taps into cognitive control, this randomised, double-blinded, placebo-controlled oral contraceptive trial set out to investigate the brain activity pattern during response inhibition in CHC users. Methods Thirty-four women were randomised to one treatment cycle with a levonorgestrel-containing CHC or placebo. The women performed a Go/NoGo task to measure brain activity during response inhibition by use of event-related functional magnetic resonance imaging (fMRI) prior to and during the CHC/placebo treatment cycle. Results No differences between CHC and placebo users in number of correct inhibitions were found during treatment, but only women on CHC significantly improved their performance between the baseline and treatment assessments. During the treatment cycle CHC users displayed decreased activity in the right middle frontal gyrus in comparison with placebo users. No other significant activations were evident between treatment groups or within groups. Conclusion Overall, CHC use had marginal effects on brain activity during response inhibition. If anything, the findings of the study may suggest reduced effort or increased efficiency in maintaining orbitofrontal cortex inhibitory cognitive control when using a combined oral contraceptive.

Keywords
Functional magnetic resonance imaging; Go/NoGo; Oestrogen; Oral contraceptives; Progestagen; Randomised clinical trial; Response inhibition
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-265145 (URN)10.3109/13625187.2015.1077381 (DOI)000375025700006 ()26291330 (PubMedID)
Funder
Swedish Research Council
Available from: 2015-10-23 Created: 2015-10-23 Last updated: 2017-12-01Bibliographically approved
Segebladh, B., Bannbers, E., Moby, L., Nyberg, S., Bixo, M., Bäckström, T. & Sundström Poromaa, I. (2013). Allopregnanolone serum concentrations and diurnal cortisol secretion in women with premenstrual dysphoric disorder. Archives of Women's Mental Health, 16(2), 131-137
Open this publication in new window or tab >>Allopregnanolone serum concentrations and diurnal cortisol secretion in women with premenstrual dysphoric disorder
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2013 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 16, no 2, p. 131-137Article in journal (Refereed) Published
Abstract [en]

Most prior studies in patients with premenstrual dysphoric disorder (PMDD) indicate a blunted hypothalamus-pituitary-adrenal axis function. However, the relationship between neuroactive progesterone metabolites, such as allopregnanolone, and hypothalamus-pituitary-adrenal (HPA) axis function in PMDD patients is relatively sparsely studied. The primary aims of this study were to assess diurnal variation in circulating cortisol and low-dose dexamethasone suppression in PMDD patients and healthy controls, and the relationship between these two HPA axis indices and allopregnanolone serum concentrations. Twenty-six women with prospectively defined PMDD and 30 healthy controls were recruited. Participants underwent diurnal sampling for cortisol serum concentrations and a low-dose dexamethasone suppression test. In addition, morning allopregnanolone serum concentrations were determined. There was no difference in diurnal secretion of cortisol and degree of dexamethasone suppression of cortisol between PMDD patients and healthy controls. However, PMDD patients with high allopregnanolone levels displayed blunted nocturnal cortisol levels in comparison with healthy controls who had low allopregnanolone serum concentrations. In women with PMDD, diurnal secretion of cortisol may be influenced by allopregnanolone levels of the luteal phase. This finding may be attributed to timing of blood sampling in the late luteal phase as well as the individual level of allopregnanolone but could potentially explain the discrepancies in results between studies examining HPA axis function in women with PMDD.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-196612 (URN)10.1007/s00737-013-0327-1 (DOI)000316146300007 ()23329007 (PubMedID)
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2017-12-06Bibliographically approved
Gingnell, M., Engman, J., Frick, A., Moby, L., Wikström, J., Fredrikson, M. & Sundström Poromaa, I. (2013). Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill: A double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology, 38(7), 1133-1144
Open this publication in new window or tab >>Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill: A double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive
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2013 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 38, no 7, p. 1133-1144Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

Most women on combined oral contraceptives (COC) report high levels of satisfaction, but 4-10% complain of adverse mood effects. The aim of this randomized, double-blinded, placebo-controlled trial was to investigate if COC use would induce more pronounced mood symptoms than placebo in women with previous history of COC-induced adverse mood. A second aim was to determine if COC use is associated with changes in brain reactivity in regions previously associated with emotion processing.

METHODS:

Thirty-four women with previous experience of mood deterioration during COC use were randomized to one treatment cycle with a levonorgestrel-containing COC or placebo. An emotional face matching task (vs. geometrical shapes) was administered during functional magnetic resonance imaging (fMRI) prior to and during the COC treatment cycle. Throughout the trial, women recorded daily symptom ratings on the Cyclicity Diagnoser (CD) scale.

RESULTS:

During the last week of the treatment cycle COC users had higher scores of depressed mood, mood swings, and fatigue than placebo users. COC users also had lower emotion-induced reactivity in the left insula, left middle frontal gyrus, and bilateral inferior frontal gyri as compared to placebo users. In comparison with their pretreatment cycle, the COC group had decreased emotion-induced reactivity in the bilateral inferior frontal gyri, whereas placebo users had decreased reactivity in the right amygdala.

CONCLUSION:

COC use in women who previously had experienced emotional side effects resulted in mood deterioration, and COC use was also accompanied by changes in emotional brain reactivity. These findings are of relevance for the understanding of how combined oral contraceptives may influence mood. Placebo-controlled fMRI studies in COC sensitive women could be of relevance for future testing of adverse mood effects in new oral contraceptives.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-188504 (URN)10.1016/j.psyneuen.2012.11.006 (DOI)000320412400018 ()23219471 (PubMedID)
Available from: 2012-12-17 Created: 2012-12-17 Last updated: 2017-12-06Bibliographically approved
Wallin Lundell, I., Sundström Poromaa, I., Frans, Ö., Helström, L., Högberg, U., Moby, L., . . . Svanberg, A. S. (2013). The prevalence of posttraumatic stress among women requesting induced abortion. European journal of contraception & reproductive health care, 18(6), 480-488
Open this publication in new window or tab >>The prevalence of posttraumatic stress among women requesting induced abortion
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2013 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, no 6, p. 480-488Article in journal (Refereed) Published
Abstract [en]

Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-206289 (URN)10.3109/13625187.2013.828030 (DOI)000327484700008 ()23978220 (PubMedID)
Available from: 2013-12-14 Created: 2013-08-30 Last updated: 2017-12-06Bibliographically approved
Kallak, T. K., Baumgart, J., Stavreus-Evers, A., Sundström Poromaa, I., Moby, L., Kask, K., . . . Nilsson, K. (2012). Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients. Climacteric, 15(5), 473-480
Open this publication in new window or tab >>Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients
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2012 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 15, no 5, p. 473-480Article in journal (Refereed) Published
Abstract [en]

Objective

Vaginal estradiol is considered contraindicated in aromatase inhibitor (AI)-treated patients because of the risk of elevated estrogen levels. This leaves limited treatment options for patients experiencing gynecological symptoms. However, in clinical practice, no precise estimation has been performed of circulating estrogens and aromatase index in postmenopausal breast cancer patients on long-lasting AI or tamoxifen treatment. 

Methods

Steroid hormones were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) and extraction radioimmunoassay (RIA). Postmenopausal AI-treated patients (n =33) were compared with tamoxifen-treated patients (n =34) and controls without vaginal treatment (n =56), with vaginal estradiol (n =25), or with estriol (n =11) treatment. 

Results

By use of LC-MS/MS, median (range) estradiol plasma concentrations were 16.7 (2.4-162.6), 31.0 (13.4-77.1), 27.2 (7.8-115.8) and 33.3 (20.3-340.1) pmol/l in AI-treated breast cancer patients, tamoxifen-treated breast cancer patients, postmenopausal controls and postmenopausal controls on vaginal estradiol, respectively. The AI-treated group and subgroups had significantly lower estradiol and estrone concentrations than all other groups(p <0.05). There was extensive interindividual variation in estradiol concentration within the AI-treated group, measured using both LC-MS/MS (2.3-182.0 pmol/l) and extraction RIA (2.4-162.6 pmol/l). The AI-treated group had lower aromatase index compared to all other groups (p <0.05-0.001).  

Conclusion

Circulating estrogen levels may have been underestimated in previous longitudinal studies of AI-treated breast cancer patients. Additional studies are required to further evaluate the role of circulating estrogens in breast cancer patients suffering from gynecological symptoms.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
National Category
Chemical Sciences
Identifiers
urn:nbn:se:uu:diva-176847 (URN)10.3109/13697137.2011.642427 (DOI)000308942500011 ()
Available from: 2012-06-26 Created: 2012-06-26 Last updated: 2017-12-07Bibliographically approved
Wallin Lundell, I., Frans, Ö., Helstrom, L., Högberg, U., Moby, L., Nyberg, S., . . . Svanberg, A. S. (2012). Post-traumatic stress disorder among women requesting induced termination of pregnancy: a Swedish multi-centre study. British Journal of Obstetrics and Gynecology, 119(S2), 2-2
Open this publication in new window or tab >>Post-traumatic stress disorder among women requesting induced termination of pregnancy: a Swedish multi-centre study
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2012 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, no S2, p. 2-2Article in journal, Meeting abstract (Other academic) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychology
Identifiers
urn:nbn:se:uu:diva-184727 (URN)000309750000006 ()
Available from: 2012-11-15 Created: 2012-11-13 Last updated: 2017-12-07Bibliographically approved
Hudecova, M., Holte, J., Moby, L., Olovsson, M., Stridsberg, M., Larsson, A., . . . Sundström Poromaa, I. (2011). Androgen levels, insulin sensitivity, and early insulin response in women with polycystic ovary syndrome: a long-term follow-up study. Fertility and Sterility, 95(3), 1146-1148
Open this publication in new window or tab >>Androgen levels, insulin sensitivity, and early insulin response in women with polycystic ovary syndrome: a long-term follow-up study
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2011 (English)In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 95, no 3, p. 1146-1148Article in journal (Refereed) Published
Abstract [en]

Thirty-four women with polycystic ovary syndrome who previously had participated in studies with intravenous glucose tolerance test and hyperinsulinemic, euglycemic clamp between 1987 and 1995 underwent anthropometric, endocrine (T and sex-hormone binding globulin serum concentration), and metabolic (intravenous glucose tolerance test, hyperinsulinemic, euglycemic clamp, and androgens) measurements. Free androgen levels and β-cell function decreased over time in women with polycystic ovary syndrome, but insulin sensitivity remained unaltered.

Keywords
Polycystic ovary syndrome, long-term follow-up, insulin sensitivity, intravenous glucose tolerance test, hyperinsulinemic, euglycemic clamp, testosterone
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-139204 (URN)10.1016/j.fertnstert.2010.09.050 (DOI)000287480300073 ()21036351 (PubMedID)
Available from: 2010-12-22 Created: 2010-12-22 Last updated: 2017-12-11Bibliographically approved
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