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The mammographic breast pattern and oral contraception.

The relationship of oral contraceptive usage to breast parenchymal patterns has been studied in 5319 self-selected women presenting to a breast screening unit. Among premenopausal women, 46.1% had taken an oral contraceptive ("the pill") in the past, and 9.5% were still taking the pill. These patients showed a decreased incidence of P2 patterns and an increased incidence of N1 patterns. Of the post-menopausal women, 14.7% had been on the pill. Similar differences of incidence of parenchymal patterns are noted in these women. The significance of these changes is unclear.

Adult↗

Serum levels of FSH, LH, estradiol-17 beta and progesterone following the administration of a combined oral contraceptive containing 20 micrograms ethinylestradiol.

An oral contraceptive containing 20 micrograms of ethinylestradiol and 250 micrograms of levonorgestrel was given to 5 normally menstruating women for two consecutive cycles. Peripheral serum levels of FSH, LH, estradiol-17 beta and progesterone were determined during the treatment period and during two control cycles, one immediately before, and one immediately after treatment. In all 5 women studied there were no LH peaks and no luteal phase levels of progesterone during the treatment cycles indicating complete inhibition of ovulation. 4 of the 5 women showed no biphasic estradiol pattern. Posttreatment control cycles showed reestablished ovulatory pattern in 4 of the 5 subjects.

Adolescent↗

Unilateral superior ophthalmic vein thrombosis in a user of oral contraceptives.

A patient on oral contraceptives over several years developed unilateral proptosis, haemorrhagic retinopathy and increase in intraocular pressure. An orbital vein venogram confirmed the diagnosis of right superior ophthalmic vein thrombosis. There was complete resolution of thrombosis and eye signs and symptoms with discontinuation of the oral contraceptive.

Adult↗

Putting risk in perspective: an evidence-based approach to selected risks associated with the use of oral contraception.

Although use of oral contraceptives is an effective way to prevent unintended pregnancy, concerns exist about associated adverse health outcomes. The concept of risk and different approaches to describing risk are discussed, and studies of health risks associated with specific exposures are used to illustrate the differences between relative and absolute risk. Evidence about health risks associated with use of oral contraceptives is presented within the context of population-based risk estimates.

Contraceptives, Oral, Combined↗

Risks of oral contraceptive use in women over 35.

Oral contraceptives are a reliable and convenient method of birth control. Nevertheless, physicians are reluctant to use them in women over 35 because of concerns about increased risks of cardiovascular disease, stroke and cancer despite evidence to the contrary. Well-designed studies have shown that the incidence of thromboembolic disease is related to the estrogen dose and that the risk of thromboembolism is highest in women who smoke. With current oral contraceptive formulations, there is no increased risk of cardiovascular disease or stroke in women without other risk factors. Oral contraceptives have been shown to protect against endometrial and ovarian cancer. The risk of breast cancer appears to be increased only minimally among current oral contraceptive users. Thus, oral contraceptives offer a safe and effective means of birth control in women over 35, especially in the absence of other risk factors.

Adult↗

Effects of three low-dose oral contraceptive formulations on lipid metabolism.

Three oral contraceptive preparations were studied in 60 healthy women. This randomized, comparative, baseline controlled study was designed to investigate the effects of the preparations on plasma lipids and lipoproteins. The following formulations were studied: a monophasic preparation containing ethinylestradiol and desogestrel (M-DSG) and two triphasic formulations containing ethinylestradiol and gestodene or levonorgestrel respectively (T-GSD and T-LNG). These preparations were studied for six treatment cycles. Total cholesterol and apoprotein B did not change in any group. Low density lipoprotein (LDL) cholesterol was significantly decreased in the groups of women treated with M-DSG and T-GSD respectively. No changes were observed in the T-LNG group. With M-DSG, significant increases were observed in high-density lipoprotein (HDL) cholesterol and HDL3 cholesterol, whilst HDL2 cholesterol did not change. With both T-GSD and T-LNG, no changes were observed in HDL cholesterol, whilst a significant increase in HDL3 cholesterol together with a trend to decrease in HDL2 cholesterol were observed. Apolipoprotein AI increased with the following ranking M-DSG greater than T-GSD greater than T-LNG. The LDL/HDL cholesterol ratio significantly decreased with both M-DSG and T-GSD. In the T-LNG group there was no change in this ratio. Triglycerides increased to the same extent in all treatment groups. As far as concerns the risk of arterial diseases, these three oral contraceptive formulations mostly induced negligible and/or partly favorable changes in plasma lipids and lipoproteins; however, the lipoprotein pattern during M-DSG treatment resulted better than during T-GSD, and the latter turned out to be better than during T-LNG.

Adolescent↗

Rise in female-initiated sexual activity at ovulation and its suppression by oral contraceptives.

This study was designed to test the hypothesis that women exhibit peaks of sexual activity at ovulation, as would be predicted from estrous effects in animals. Married women who used contraceptive devices other than oral contraceptives experienced a significant increase in their sexual behavior at the time of ovulation. This peak was statistically significant for all female-initiated behavior, including both autosexual and female-initiated heterosexual behavior, but was not present for male-initiated behavior except under certain conditions of contraceptive use. Previous failures to find an ovulatory peak may be due to use of measures of sexual behavior that are primarily determined by initiation of the male partner. Women using oral contraceptives did not show a rise in female-initiated sexual activity at the corresponding time in their menstrual cycles, probably owing to the suppression of ovulatory increases in hormone secretion by the oral contraceptives.

Adult↗

Homozygous patients with APC resistance may remain paucisymptomatic or asymptomatic during oral contraception.

The effect of oral contraceptive therapy was studied in five patients with homozygous activated protein C resistance. Patients with this congenital abnormality, in contrast to those with antithrombin, protein C or protein S deficiencies, showed only a mild thrombotic tendency. In fact, only two of six observations (one patient took the pill on two separate occasions many years apart) showed deep vein thrombosis. No patient had pulmonary embolism. Two additional patients had a superficial vein thrombosis of the legs. In two instances, a superficial vein thrombosis and a deep vein thrombosis, concomitant risk factors were present (immobilization and surgery for an ovarian cyst, respectively). However, compared with heterozygous for the same abnormality, the symptomatic homozygous patients with APC resistance appeared to develop thrombosis after a shorter period of oral contraception.

Adult↗

Relationship between levels of blood lipids, vitamins C, A, and E, serum copper compounds, and urinary excretions of tryptophan metabolites in women taking oral contraceptive therapy.

To evaluate which women using oral contraceptive agents might be at risk, biochemical indices known to be affected by the estrogens and progestogens were studied in women who take oral contraceptive agents, in women who do not use oral contraceptive agents, in women in third trimester of pregnancy and 6 weeks after parturition, and in men with normal and high blood lipid levels. The most consistent changes due to oral contraceptive agents were in serum levels of copper, triglycerides, and vitamin A and in the urinary excretion of xanthurenic acid and niacin derivatives before and after a tryptophan load test. There was only a slight suggestion, with no statistical significance, that serum vitamin C levels decreased when the serum levels of ceruloplasmin were high. The highest blood pressures and serum triglycerides and vitamin A levels were obtained in those women who ingested the highest level of estrogens. Pregnant women had the lowest levels of serum vitamin A. The oral contraceptive agents users had the lowest average levels of carotenoids corresponding to the highest average levels of vitamin A in the serum. Thus, estrogens not only increase the rate of change of tryptophan to niacin but may also increase the rate of conversion of carotene to vitamin A. Relative reactivity to oral contraceptive agents and possible risk to a patient might be evaluated by a profile of blood pressure and serum triglycerides, copper, and vitamin A.

Adult↗

New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes.

Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA). As safety information changes, however, checklists can quickly become outdated. Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives. In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods. Based on these criteria, new checklists for COCs and DMPA were developed. This article describes the new checklists and their development. Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements. Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility. These findings indicated the need for a checklist guide. In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use. The article reflects also the resulting updated checklist.

Community Health Services↗

Oral contraceptives, clotting factors, and thrombosis.

Oral contraceptives (OCs) raise the plasma levels of some clotting factors, especially factor VII. Until recently, however, there has been no evidence for a relationship between high levels of clotting factor and the onset of clinically manifest vascular disease. It has not been established, on a preliminary basis, that high levels of factors VII and VIII and of fibrinogen in men are associated with an increased risk of death from cardiovascular disease. There is a strong relationship between OC estrogen dose and the level of factor VII, a clotting factor with a number of other characteristics, suggesting that high levels would be thrombogenic. A strong relationship also exists between OC estrogen dose and the risk of thromboembolism. The thrombotic effects of OC are probably mediated, at least partly, through their effects on the coagulation system.

Animals↗

Effect of oral contraceptives on haemostasis variables.

Combined oral contraceptives (COCs) have effects on a large number of haemostasis variables. We have summarised literature data on effects of COCs containing 30-35 micrograms ethinyl estradiol for the third generation of progestogens (PGs): desogestrel, gestodene and norgestimate. It is concluded that about 15 variables show a shift in distribution of the order of magnitude of their interindividual variation coefficient. When comparing the third generation of PGs with the second one (norgestrel, levonorgestrel) stronger increases are noted for the former for some haemostatic variables. Also differences between desogestrel and gestodene for factor VII were apparent. It indicates that the role of PGs in the effects of COCs is significant and their design may in addition to reduction of oestrogen dosage be important in reducing haemostatic complications. The survey on molecular and cellular mechanisms by which the sex steroids might operate showed a great lack of knowledge. Only for factor XII has a functional oestrogen response element in the DNA definitely been identified. The study of molecular markers of coagulation and fibrinolysis have shown a distinct increased activation of coagulation (F 1 + 2, FPA) and fibrinolysis (PAP), and an increased fibrin turn-over (increased FDPs); platelet products are not found increased (beta TG, PF-4). The increase in fibrinolysis represent a counterforce, but individual changes in variables in coagulation and fibrinolysis do not correlate indicating independent effects and no evidence for a individually regulated balance. A first step in further research might be in understanding the increase in coagulation activation (F 1 + 2) which has so far not been satisfactorily related to changes in blood concentrations of haemostatic factors and possibly local factors.

Biomarkers↗

Analysis of a multicentre trial of a new low-dose oral contraceptive in Great Britain.

An oral contraceptive containing D-norgestrel 150 mug. and ethinol oestradiol 30 mug. (Neovletta) was tested in 682 British women during more than 6,000 cycles. The pregnancy rate was 0.2 per 100 woman-years with the exclusion of pregnancies that followed admitted errors of tablet-taking, and 0.8 per 100 woman-years when they were included. 92.2 per cent of cycles were within 28 +/- 3 days. withdrawal-bleeding was missed in 3.3 per cent of cycles. Spotting occurred in 9.3 per cent of cycles and breakthrough bleeding in 5.8 per cent. Total bleeding averaged 4.71 days per cycle. Concurrent symptoms likely to be attributable to the pill were few and only 10.3 per cent of subjects withdrew because of them. It can be concluded that this formulation is extremely well tolerated and highly effective.

Clinical Trials as Topic↗