RISK OF CHRONIC RHINOSINUSITIS AMONG HORMONAL CONTRACEPTIVE USERS VERSUS NON-USERS — A CASE-CONTROL STUDY AT CAREER INSTITUTE OF MEDICAL SCIENCES & HOSPITAL, LUCKNOW

Background Chronic Rhinosinusitis (CRS) is a highly prevalent, debilitating inflammatory condition of the sinonasal mucosa. Epidemiological evidence suggests distinct sex-based differences in disease prevalence and symptom burden. Female sex hormones, particularly estrogen and progesterone, are known to modulate mucosal physiology and inflammation through receptor binding in the nasal tissues. While hormonal contraceptives (HCs) have been linked to an increased risk of allergic rhinitis (AR) , their association with the development of objectively diagnosed, long-term structural sinonasal disease (CRS) remains inadequately explored, especially within the context of high environmental inflammatory burden characteristic of South Asian settings like Lucknow, India. Objectives: This study aimed to determine the association between the duration of systemic hormonal contraceptive use and the risk of chronic rhinosinusitis among reproductive-age women presenting at a tertiary care center in Lucknow, India, between June and December 2019, while controlling for major established and regional confounding factors. Methods: A retrospective, 1:1 age-matched, hospital-based case-control study was conducted at the Career Institute of Medical Sciences & Hospital from June 1, 2019, to December 31, 2019. Cases ( N=100) were women aged 18–45 years with confirmed CRS (symptoms ≥12 weeks plus objective findings via endoscopy or computed tomography). Controls ( N=100) were recruited from non-sinonasal clinics, individually matched for age (±2 years). Exposure was defined as lifetime systemic HC use (pill, injectable and implant). Data on confounding variables, including history of allergy/asthma, Deviated Nasal Septum (DNS), smoking, and Indoor Air Pollution (IAP) exposure (cooking fuel type), were collected using a standardized questionnaire. The association was quantified using Odds Ratios (ORs) derived from conditional logistic regression, controlling for significant confounders. Result: Systemic HC use was significantly more prevalent among cases (60.0%) than controls (25.0%). The crude Odds Ratio for ever use of HC was 4.50 (95% CI: 2.50–8.10; P<0.001). After adjustment for age (by matching), history of allergy/asthma, DNS, and IAP exposure, the association remained statistically significant: Adjusted Odds Ratio (aOR) 3.15 (95% CI: 1.65–6.00). A clear dose-response relationship was observed, with cumulative HC use lasting ≥5 years conferring the highest risk (OR 5.20; 95% CI: 1.55–17.40). Conclusions: Systemic hormonal contraceptive use is independently associated with a significantly increased risk of chronic rhinosinusitis, with the risk escalating substantially with the duration of use. These findings underscore the need for greater clinical consideration of HC history in the management and diagnostic workup of female patients presenting with chronic sinonasal symptoms in this regional setting.