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Etiology, clinical features and prognosis in secondary amenorrhea.
A clinical investigation of 356 patients with secondary amenorrhea revealed that 95% of patients with postpill amenorrhea and 56% of patients with anorexia nervosa recovered in 6 years. The corresponding recovery rates for patients with psychogenic amenorrhea and amenorrhea following self-induced weight loss were 72% for both groups, and in patients with the amenorrhea-galactorrhea syndrome and idiophatic functional amenorrhea the recovery rates at 6 years were 64 and 61% respectively. Unlike the other groups with functional amenorrhea, patients with the amenorrhea-galactorrhea syndrome had impaired ovarian responsiveness to exogenous gonadotropins. Bromocriptine treatment resulted in disappearance of the galactorrhea and restoration of the menses and/or ovulation in nine of 18 patients; of these three became pregnant. The effect of bromocriptine did not persist for long after treatment ceased, and permanent recovery was recorded only in four patients. The group with functional amenorrhea included 34 patients who wished to become pregnant. Gonadotropin treatment was successful in 20 patients, clomiphene-hCG in two, tamoxifen in two, bromocriptine in two, and combined bromocriptine and clomiphene in one. Thus, the overall pregnancy rate in patients with functional amenorrhea was 79%. The groups with ovarian amenorrhea inclutients with assumed ovarian failure responded to large doses of exogenous gonadotropins by ovulation and three became pregnant. Ovarian wedge resection was ineffective in all five cases with polycystic ovaries, but two patients became pregnant after treatment with clomiphene and chorionic gonadotropin, and one with exogenous gonadotropins.
Benign hepatic tumors and oral contraceptive pills.
In order to consider possible environmental factors related to the development of benign hepatic tumors, all reports of this disorder in the case records of five different hospitals in Rochester, New York, during the past 10 years were reviewed. Seven patients with benign hepatic tumors of the liver and two with peliosis hepatis were identified. Among the seven with a benign hepatic tumor, four were women currently receiving oral contraceptives; one had been receiving this medication in the past, and two had no history of exposure to any steroid whatsoever. The two patients with peliosis hepatis were receiving long-term androgenic anabolic steroids. Dilated, thin-walled vessels and vascular spaces were a more prominent feature of the tumor seen in four patients receiving oral contraceptive pills. It is emphasized in this report that benign hepatic tumors do occur in men and in patients with cirrhotic liver without the use of any kind of steroids.
Epithelial changes in the oral mucosa resulting from a variation in hormone stimulus.
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Pituitary adenoma and oral contraceptives: a case-control study.
A search of the centralized data resource available at the Mayo Clinic for all cases of pituitary adenoma diagnosed in the population of Olmstead County, Minnesota, disclosed an increasing incidence of this tumor in women of childbearing age. The sex, age, and temporal relationships suggest that, if this increase is real, oral contraceptives should be considered as one of the possible etiologic factors. A case-control study, however, did not reveal an association of prior use of oral contraceptives with pituitary tumor--relative risk, 0.5; 95% confidence interval, 0.1 to 2.2. No association was found with other possible risk factors, i.e., prior head injury, radiation therapy, seizures, and smoking. Thus, unless other etiologic agents can be identified, it appears that the increasing incidence is due to advances in diagnostic and surgical technology rather than to a specific etiologic factor.
Nutrition during pregnancy, lactation, and oral contraception.
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[Menopause, estrogens and genital cancer].
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Effect of oral contraceptives on plasma androgenic steroids and their precursors.
Plasma dehydroepiandrosterone (DHEA), its sulfate ester (DHEAS), and androstenedione (A2), delta5-pregnenolone (delta5-P), and 17 alpha-hydroxypregnenolone were measured in women using estrogen-containing oral contraceptives and in female controls of similar age. All three androgenic steroids and their two C21 precursors were reduced in the oral contraceptive users compared with the controls. It is concluded that oral contraceptives cause a decrease in plasma DHEA, DHEAS, and A2, one possible mechanism for which is the inhibition of delta5-P synthesis from cholesterol.
Effect of progestins on glucose and lipid metabolism.
Gestamimetic amounts of progesterone enhance basal and glucose-stimulated insulin production. Contraceptive doses of synthetic progestins cause a moderate increase or no change in glucose-stimulated insulin production, depending on route of administration and species tested. Estrogens potentiate the insulinotropic effects of progesterone and the synthetic progestins. Basal serum triglyceride concentrations are generally unaffected by progesterone or 17 alpha-acetoxyprogesterone treatment but may decrease during 19-nortestosterone administration. Glucose tolerance does not change during treatment with gestamimetic doses of progesterone alone but may improve in rats and monkeys during concurrent estrogen administration. By contrast, deterioration of glucose tolerance is observed in women treated concurrently with synthetic estrogen plus 19-nortestosterone derivatives and, occasionally, with 19-nortestosterone derivatives alone. No consistent changes in glucose metabolism have been observed after treatment with 17 alpha-acetoxyprogesterone derivatives alone. The cause of the species-related differences in glucose metabolism during 19-nortestosterone treatment is obscure.
[Principle complications and contraindications of the use of oral contraceptives].
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Effect of drugs on chromosome structure.
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Factors affecting pituitary gonadotropin function in users of oral contraceptive steroids.
In order to determine whether certain factors influence the direct pituitary suppressive effect of contraceptive steroid, 50 subjects who had used various formulations of oral contraceptive steroids for periods of time ranging from one to nine years were stimulated with 50 microgram of gonadotropin-releasing hormone (GnRH) during the last week of oral contraceptive ingestion. The response of lutinizing hormone (LH) and follicle-stimulating hormone (FSH) was compared to the results obtained in nine control subjects with regard to: (1) age of subject. (2) type of contraceptive formulation used, and (3) length of use. Prestimulation levels of LH and FSH, respectively, were significantly decreased in 37 (74 per cent) and 42 (84 per cent) of the subjects. Following GnRH stimulation, peak responses of serum LH and FSH, respectively, were also significantly lower than those in the control subjects in 40 (80 per cent) and 45 (90 per cent of the subjects. The degree of suppression of pituitary gonadotropins, both before and after GnRH administration was significantly correlated with the type of steroid formulation used, being greatest with a combination of d-norgestrel and ethinyl estradiol. No correlation was found with length of use of oral contraceptives or age of the subjects.
Effects of estrogens and progestins on high density lipoproteins.
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[Endometrial cytology and copper containing intrauterine devices].
Copper-containing intrauterine devices (IUDs) for contraception are increasingly used within recent years. IUDs in situ provoke a non-specific inflammatory cell reaction, particularly at the glandular epithelium of the endometrium. The cellular changes include swelling of the cytoplasm and of the nuclei, the latter showing chromatin clumping, prominent nuclei and a pseudoeosinophilic reaction. Cytoplasmic changes exhibit vacuolation, incorporation of leukocytes and plasmolysis varying in degree. The local inflammation also accounts for the side effects associated with the device, such as uterine bleeding and endometritis. Cytomorphologically, the differentiation between cellular inflammation through IUDs and inflammatory metaplasia is difficult, particularly if the investigator has no information about the presence of an IUD. Intrauterine application of proteinase inhibitors can be helpful in differential diagnosis of such IUD-mediated cellular changes.
Actinomycetes-like organisms in wearers of intrauterine contraceptive devices.
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The effect of various contraceptive hormonal therapies in women with normal and diabetic oral glucose tolerance test.
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[Nature of the ovulation and the state of the preimplantation fetuses in the experimental administration of hormonal and neurotropic agents].
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Actinomycetes and the IUD: an update.
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