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PubMed2003

Decreased maximal aerobic capacity with use of a triphasic oral contraceptive in highly active women: a randomised controlled trial.

BACKGROUND: Oral contraceptives are commonly used by women athletes. However, their effect on athletic performance is unclear. OBJECTIVES: To examine the effects of a moderate dose, triphasic oral contraceptive on measures of athletic performance in highly trained women athletes. METHODS: This is a double blind, placebo controlled trial in 14 women with ovulatory menstrual cycles and maximal aerobic capacity (VO(2)MAX) >/==" BORDER="0">50 ml/kg/min. Four measures of athletic performance were tested: VO(2)MAX, anaerobic capacity (anaerobic speed test), aerobic endurance (time to fatigue at 90% of VO(2)MAX), and isokinetic strength (Cybex II dynamometer). Height, weight, and six skinfold measurements were also recorded. All these observational tests were completed during both the follicular and mid-luteal phases of an ovulatory menstrual cycle. Cycle phases were confirmed by assaying plasma oestradiol and progesterone. Participants were subsequently randomly assigned to either a tricyclic oral contraceptive or placebo and retested in identical fashion (oral contraceptive phase). RESULTS: Absolute and relative changes in VO(2)MAX from follicular to oral contraceptive phase decreased in the oral contraceptive group by 4.7%, whereas the placebo group showed a slight increase (+1.5%) over the same time period. Two of the women taking oral contraceptive had decreases of 4 and 9 ml/kg/min. In contrast, most women in the placebo group improved or maintained VO(2)MAX. There was also a significant increase in the sum of skinfolds in women taking oral contraceptive compared with those taking placebo (p<0.01). There were no significant changes in other physiological variables (maximum ventilation, heart rate, respiratory exchange ratio, packed cell volume) or measures of performance (anaerobic speed test, aerobic endurance, isokinetic strength) as a function of oral contraceptive treatment. CONCLUSIONS: The decrease in VO(2)MAX that occurs when oral contraceptive is taken may influence elite sporting performance in some women. Further studies are required to determine the mechanisms of this change.

Adolescent↗

PubMed1993

[Safety, efficacy and control of the menstrual cycle by a monophasic oral contraceptive containing 75 mcg of gestodene and 30 mcg of ethynyl estradiol].

Al oral monophasic contraceptive formulation containing gestodene (75 mcg) and ethynilestradiol (30 mcg) is evaluated concerning its safety, efficacy and cycle-control. Sixty-seven healthy women were included, allowing a total of 574 evaluable cycles. This formulation showed a high degree of efficacy, with no pregnancies after its utilization. Side affects were similar or lower to other reported with another hormonal contraceptive oral formulations. Hematologic, biochemical or urinary parameters were not altered. An acceptable menstrual pattern was maintained. In conclusion, this formulation constitutes an oral contraceptive with a high efficacy rate, a well degree of acceptability and with a side effects profile similar or lower than those produced by other oral contraceptives.

Contraceptives, Oral↗

PubMed1980

Effects on sex hormone binding globulin of different oral contraceptives containing norethisterone and lynestrenol.

Six combined oral contraceptive drugs containing ethinyloestradiol or mestranol and norethisterone or lynestrenol were studied throughout six 21-day cycles in healthy female volunteers. There was always one menstrual cycle without treatment between every treatment cycle. Plasma levels of norethisterone were determined throughout treatment by use of a specific radioimmunoassay. Sex hormone binding globulin (SHBG) was measured by an ammonium sulphate precipitation method at the beginning and at the end of each treatment cycle. The results indicated an accumulation of norethisterone in plasma when 1 to 3 mg of norethisterone or lynestrenol was given. There was no obvious accumulation during treatment with 0.5 mg norethisterone. SHBG increased during treatment with all combinations studied. However, this increase was most pronounced with the 50 microgram ethinyloestradiol/l mg lynestrenol, 50 microgram mestranol/l mg norethisterone and 35 microgram ethinyloestradiol/0.5 mg norethisterone combinations. There was no statistically significant increase in SHBG with 50 microgram ethinyloestradiol/2.5 mg lynestrenol or 50 microgram ethinyloestradiol/3 mg norethisterone acetate combinations. The results indicated that the induction of SHBG by the synthetic oestrogens was antagonized by the progestogens in a dose-dependent manner. The effect on SHBG by a combind preparation could be one assessment of the oestrogenicity or androgenicity of the preparation.

Adult↗

PubMed2006

Efficacy, acceptability and tolerability of the combined contraceptive ring, NuvaRing, compared with an oral contraceptive containing 30 microg of ethinyl estradiol and 3 mg of drospirenone.

PURPOSE: This randomized multicenter, open-label, trial compared efficacy, acceptability, tolerability and compliance of NuvaRing with a combined oral contraceptive (COC), containing 30 microg of ethinyl estradiol (EE) and 3 mg of drospirenone. METHOD: In this 13-cycle study, 983 women were randomized and treated (intent-to-treat population) with NuvaRing or COC. RESULTS: One in-treatment pregnancy occurred with NuvaRing (Pearl Index=0.25) (95% confidence interval [CI]: 0.006, 1.363) and four with the COC (Pearl Index=0.99) (95% CI: 0.269, 2.530). For both groups, compliance (89.2% NuvaRing, 85.5% COC) and satisfaction (84% NuvaRing; 87% COC) were high; the vast majority of women found NuvaRing easy to insert (96%) and remove (97%). Tolerability was similar; the most frequent adverse events with NuvaRing were related to ring use, whereas estrogen-related events were more common with the COC. CONCLUSION: NuvaRing has comparable efficacy and tolerability to a COC containing 30 microg of EE and 3 mg drospirenone. User acceptability of both methods was high.

Adolescent↗

PubMed1976

Massive colonic bleeding and oral contraceptive "pills".

Two patients on oral contraceptives who developed massive colonic bleeding have been presented. The clinical course and various studies suggest the mesenteric insufficiency syndrome as being a possible result of oral contraceptive effect on mesenteric vasculature. Although no definite histologic confirmation is available, the onset, course, and follow-up of these patients suggest contraceptive-induced massive colonic bleeding. The spectrum of oral contraceptive-induced colonic bleeding may vary from mucosal injury with massive colonic bleeding to transmural infarction. Only the clinical follow-up would determine the severity of the involvement and that would determine whether surgical intervention will be necessary.

Adult↗

PubMed2004

Evidence for practice: oral contraception and risk of cervical cancer.

PURPOSE: The issue of continued oral contraceptive use among women with abnormal Pap smears may be controversial due to reported evidence of an increased risk of cervical cancer among long term oral contraceptive users. This article reviews the evidence concerning oral contraception and cervical cancer risk. The role of Human Papilloma virus (HPV) and proposed mechanisms for the development of cervical cancer are explained. Evidence from World Health Organization (WHO) studies and additional research evidence are discussed. Implications for clinical practice are included. DATA SOURCES: WHO commissioned studies, additional relevant studies searchable from an EBSCO database, and texts that describe the natural history of HPV. CONCLUSIONS: Epidemiological studies and biomedical research suggest a role for steroid hormones, such as oral contraceptives, in facilitating the action of HPV. However, a majority of HPV infections resolve spontaneously, despite widespread use of oral contraception. Oral contraception does not appear to increase incident HPV infection or persistence of HPV infection. The benefits of oral contraceptives appear to outweigh the risks associated with HPV facilitation. IMPLICATIONS FOR PRACTICE: NPs inform patients of abnormal Pap smears, manage the clinical care of women at risk of cervical cancer, and provide educational counseling regarding contraceptive choices. Ethical considerations include clear disclosure of potential risk. However, a risk-benefit analysis supports continued use of oral contraception among women who have abnormal Pap smears but also have access to clinical surveillance.

Cocarcinogenesis↗

PubMed2002

Quick start: novel oral contraceptive initiation method.

Conventional oral contraceptive (OC) starting instructions require waiting until menses to begin the OC. The conventional approach requires detailed patient education about when to begin and also may require the use of less effective or less acceptable interim contraceptive protection until menses. At our urban family planning clinic, we routinely offer patients starting the OC the option of taking the first tablet sooner. We prospectively evaluated predictors of short-term OC continuation among 250 OC requestors who were offered several approaches to OC initiation. Telephone follow-up of 91% of participants showed that women who swallowed the first OC in the clinic were more likely to continue the OC until the second package than women who planned to start the OC later (adjusted OR 2.8, 95% C.I. 1.1-7.3). Other factors associated with short-term continuation were: partner's knowledge of planned OC use, older age, and participant's agreement that she would be very unhappy about becoming pregnant in the next 6 months.

Abortion, Induced↗

PubMed2006

Fibrinolytic response to exercise in women using third-generation oral contraceptives.

The use of oral contraceptives (OC) is associated with an increased risk of thrombosis, suggesting OC exert procoagulant and/or antifibrinolytic effects. Given that physical exercise physiologically leads to an activation of blood coagulation and fibrinolysis, this study tested the hypothesis that OC might compromise the fibrinolytic response to exercise. Fibrinolytic variables were measured in 10 women (24 +/- 2 years) using OC (a formulation containing 30 micro g ethinylestradiol and 150 micro g desogestrel) and in 11 women without OC (mean +/- SD, 27 +/- 3 years) before, during and after a 1-h run on a treadmill at a velocity corresponding to an oxygen demand of 75-80% of maximum (anaerobic threshold). Exercise testing gave rise to considerable increases of tissue-type plasminogen activator antigen by seven-fold to eight-fold in women taking and not taking OC alike. In the presence of unchanged plasma levels of plasminogen activator inhibitor-1, exercise-induced release of tissue-type plasminogen activator led to enhanced plasmin formation with respect to plasmin-antiplasmin complexes, rising by (mean +/- standard error) 701 +/- 77 ng/ml (P < 0.001) in women using OC and by 695 +/- 117 ng/ml (P < 0.001 versus baseline; NS versus OC users) in controls. The fibrinolytic response to intensive physical exercise is preserved in women using OC and is similar to women not using OC.

Adult↗

PubMed1973

Cryptogenic cerebral embolism in women taking oral contraceptives.

Fourteen women taking oral contraceptives were admitted during a five-year period because of acute cerebrovascular lesions. A diagnosis of major cerebral embolism was established in four of them. No source of embolism was found, and thorough investigation failed to reveal any predisposing illness. Cerebral embolism was a probable diagnosis in several of the remaining 10 patients. A comparison was made with the strokes occurring in women not taking contraceptive pills in corresponding age groups.

Adult↗

PubMed1992

Oral contraceptives: an epidemiological perspective.

Oral contraceptives (OCs) containing a fixed dose of estrogen and progestogen in a 21-day regimen initially were approved for unrestricted use in the 1960s in the United States. OCs have been used and studied extensively for more than 30 years. They have always been seen as providing excellent efficacy. However, estrogens were associated with major risks in the use of OCs. In the early 1960s, case reports of thromboembolism in women using OCs led to epidemiological studies suggesting a correlation between deep vein thrombosis and the estrogen content of the pill. Research focused on decreasing the estrogen dose. In the evolution process, the combination monophasics of the early 1960s gave way to the sequential pill and the "mini pill" of the 1970s. Sex steroids given in the form of OCs were shown to alter lipoprotein and carbohydrate metabolism. This, together with the increased risk of thromboembolism, led to increased risk of cardiovascular disease, e.g., myocardial infarction. Little consideration (in the early 1960s) was given to the effects of potent progestogens and their interaction with estrogens. Hence, the recent focus of clinical research is the development of new and improved progestational agents. These third-generation gonane types appear to have little impact on carbohydrate or lipoprotein metabolism while maintaining excellent efficacy and cycle control. They should reduce the risk of serious side effects. However, to understand how and why these agents evolved, tracing the history of OC development is valuable. It might allow us to determine the baseline dose where we will begin to lose some of the OCs' benefits.

Adult↗

PubMed1986

Desogestrel-containing oral contraceptives and blood pressure.

Oral contraceptives (OCs) containing 0.150 mg desogestrel plus 0.020 or 0.030 mg ethinylestradiol (Marvelon) were studied with respect to their effect on blood pressure. Data on 3,421 women were obtained covering 41,132 treatment cycles. The drop-out rate due to hypertension was 2.92 per thousand women-years (TWY). Mean changes in blood pressure were small, indicating that low doses of ethinylestradiol when combined with desogestrel do not adversely affect blood pressure.

Adult↗

PubMed1985

[Unintended effects of oral contraceptives. I.Estrogen-related effects].

Oral contraceptives are almost optimally effective but not yet perfectly safe. They can cause favourable or adverse unintended effects which cannot always be attributed to either the estrogen or the progestagen; however, in many instances a fair differentiation is possible. Type, intensity and frequency of side effects depend on dosage, duration of administration and on the structure of the substance. Some favourable side effects of estrogens are used for therapeutic purposes. Adverse side effects of estrogens are either subjectively disturbing only, or medically important, but few are life threatening. Dose dependence has been established, a structure relationship is unlikely.

Body Weight↗

PubMed1988

The interaction of alcohol consumption and oral contraceptive use on lipids and lipoproteins.

Oral contraceptive (OC) use and alcohol consumption have been shown to alter the levels of lipids and lipoproteins in the blood. The effect of alcohol consumption on levels of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, LDL-B, Apo-A1, the ratio of HDL cholesterol/total cholesterol, HDL cholesterol/LDL cholesterol, and the ratio of LDL cholesterol/LDL-B among normal healthy young women before initiation of oral contraceptives and after six months of oral contraceptive use are both described. Of primary interest is the mediating effect of alcohol consumption on the association between steroid usage and blood lipid values. At baseline, ethanol consumption was found to be positively associated with triglycerides, HDL-C, and Apo-A1 and negatively associated with LDL-C/LDL-B. After adjustment for several covariables, alcohol consumption was found to be positively associated with the increases in triglycerides and in Apo-A1 observed at 3 and 6 months after initiation of OCs. Since these two parameters are believed to have opposite relationships to cardiovascular disease, the effect of alcohol consumption remains uncertain.

Adult↗

PubMed1982

Pituitary responsiveness to gonadotropin-releasing hormone (GnRH) and thyrotropin-releasing hormone (TRH) during different phases of the same cycle of oral contraceptive steroid therapy.

To study the pituitary luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), and thyroid-stimulating hormone (TSH) secretory capacity and to determine whether the gonadotropes, lactotropes, and thyrotropes have a circatrigintan cycle of variation under hormonal contraception, women under combined oral contraceptive steroid treatment were challenged with a combination of 100 micrograms of gonadotropin-releasing hormone (GnRH) and 200 micrograms of thyrotropin-releasing hormone (TRH) given intravenously at weekly intervals. Significant releases of LH (P less than 0.001), FSH (P less than 0.05), PRL (P less than 0.001) and TSH (P less than 0.001) occurred in response to GnRH-TRH. The LH integrated change score (ICS), calculated as the difference between post-GnRH-TRH hormonal release and the average baseline levels, was higher (P less than 0.001) after ingestion of tablet 7 than after the 7th day after ending the previous cycle of treatment and after ingestion of tablet 21. The FSH ICS decreased as the cycle of treatment advanced in comparison with the ICS of the 7th day after the end of the previous cycle of treatment. The PRL and TSH ICS were not influenced by oral contraceptives. The LH, FSH, PRL, and TSH releases were not influenced by the dose of estrogens given daily.

Adolescent↗

PubMed2003

Potential bias due to excluding oral contraceptive users when estimating menstrual cycle characteristics.

Women take oral contraceptives for contraception but also for menstrual dysfunction treatment. This raises the question of whether or not women with menstrual dysfunction are underrepresented in analyses of menstrual function because oral contraceptive users are excluded. To explore this, the authors examined the history of oral contraceptive use among 1322 Black women and White women, aged 35-49 years, who had been randomly selected from a large health plan's membership in Washington, DC, between 1996 and 1999. The women reported whether they took oral contraceptives during their teens, twenties, and thirties, and if so, the reason they took them (prevent pregnancy, medical problem, or both). They also reported their usual menstrual cycle length when not using oral contraceptives during these decades. The prevalence of oral contraceptive use strictly for medical problems was low for both Black women and White women (4-9% of women), and the distributions of usual cycle length were similar for women who did and did not take oral contraceptives. Thus, there was little evidence of substantial bias of estimates of cycle characteristics caused by excluding oral contraceptive users from analyses of menstrual function. However, our data indicate that, with only a few additional questions, information on usual menstrual cycle characteristics can be collected and used to evaluate bias in any given study.

Adult↗

PubMed1982

A randomized, double-blind study of two combined and two progestogen-only oral contraceptives.

A randomized double-blind study of two combined oral contraceptives and two progestogen-only oral contraceptives was conducted using the same protocol at WHO Collaborating Centres for Clinical Research in Human Reproduction in Bombay and Ljubljana of the 518 women admitted to the trial, 123 received mestranol 50 micrograms + norethisterone 1mg (MES 50 + NET 1); 137 received ethinyl estradiol 30 micrograms + levonorgestrel 150 micrograms (EE 30 + LNG 150); 130 received norethisterone 350 micrograms/NET 350); and 128 received levonorgestrel 30 micrograms (LNG 30). At one year, between 52.6 and 61.0 percent of those recruited had discontinued oral contraceptive use for all reasons, and by two years, between 70.5 and 76.5 percent had discontinued the treatment. These rates did not differ between the four treatment groups. However, discontinuation rates for all medical reasons at one and two years, and at two years pregnancy rates and discontinuation rates for bleeding disturbances, were significantly lower in the EE/LNG preparation. The groups receiving the MES/NET, LNG and NET had similar pregnancy rates, discontinuation rates for all medical reasons and all bleeding disturbances. There were two ectopic pregnancies among the 22 pregnancies in the progestogen-only groups. Discontinuation because of headache, dizziness and other central nervous system symptoms were significantly more common in those receiving MES/NET compared to EE/LNG. In contrast, discontinuation for gastro-intestinal disturbances were significantly higher in the EE/LNG combined preparation. Bleeding disturbances in the first few cycles tended to be higher in NET than in the LNG group. The data suggest that greater consideration be given to the benefits and risks of including progestogen-only oral contraceptives in the family planning programmes of some countries.

Adolescent↗

PubMed1978

Distribution - on or off prescription (of oral contraceptives)?

Restrictions on sale of oral contraceptives (OCs) in Australia are based on their classification as Schedule 4 poisons; as such they are "restricted substances" and obtainable only on a prescription. In general only a medical practitioner can prescribe OCs and only a chemist or a licensed person can dispense them. Doctors at Family Planning Clinics and Hospital Outpatient Departments may also supply OCs. There are arguments for and against a relaxation of restrictions controlling the distribution of OCs, many of these views were stated in submissions to the Royal Commission on Human Relationships. At present in Australia, a nurse must work under the supervision of a medical practitioner when providing family planning services. A doctor may delegate certain functions to nursing staff but remains ultimately responsible. The Royal Commission "suggests that steps should be taken to enable nurse practitioners to take a wider role in prescribing oral contraceptives." They also think "that the pill should be available only through a person trained to give information and advice on its proper use. (They) would not necessarily restrict the categories of such persons; they might include nurses, or other specially trained personnel, at family planning clinics, specially trained social workers, pharmacists, and possibly others. It would be important to establish proper standards for training these personnel and for their competence to be recognized by the Commonwealth and States under appropriate legislation. This would require cooperation. The Family Planning Associations or other recognized training bodies could be authorized to issue certificates of competence to persons who have received the appropriate training; this would in turn authorize those persons to prescribe OCs. When more is known about the OC it is hoped that it will be possible to make it available without restriction.

Australia↗

PubMed1984

Absence of antibodies to ethinyl estradiol in users of oral contraceptive steroids.

Sera from current and past oral contraceptive users, never-users, and never-users with venous thrombosis were examined for immunoglobulin G (IgG) which was precipitable at 25% or 33% saturation with ammonium sulfate or which showed specific binding of ethinyl estradiol. No increase in "specific" IgG and no evidence of ethinyl estradiol binding was observed in oral contraceptive users. This provides no support for the claim that a significant percentage of oral contraceptive users develop a special IgG, precipitable at 25% ammonium sulfate saturation and showing high binding affinity to ethinyl estradiol, which may be causally linked to the development of thrombotic phenomena in oral contraceptive users.

Antibodies↗