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PubMed1976

Potencies of oral contraceptives.

Oral contraceptives are combinations of estrogens and progestogens or, in the case of the mini-pills, progestogens alone. With specific test procedures in laboratory animals or human subjects, it is possible to assign potency evaluations to the components relative to the progestational, estrogenic, or antiestrogenic activities of the progestogen or to the estrogenic potencies of the estrogenic component. It might even be possible to quantify the synergistic effects of the estrogen on the progestational agent. Unfortunately, however, it is impossible now to amalgamate such assay results into single estimates of the potencies of the combinations (either the combination products per se or the combination tablets of sequential products). For example, an over-all estrogenic potency of a combination preparation would involve the integration of contributions form the estrogen itself plus the estrogenic products of metabolism of the progestogen minus the antagonistic effect of the progestational agent, if any. These factors cannot now be quantified independently, much less merged into a single figure of clinical significance. Further, even if it were possible to produce such an estimate, it is unlikely that the evaluation would be meaningful in relation to any putative side effect or adverse reaction, i.e., the alleged thrombogenic effects of oral contraceptives cannot currently be related directly to any measure of potency that will allow prediction of these clinical conditions from laboratory models. Any evaluation of the potential of a given contraceptive to produce a specific side effect will depend upon data generated with specific regard to that adverse reaction and the individual product in question.

Contraceptives, Oral↗
PubMed1976

A current appraisal of side effects of oral contraceptives.

Oral contraception, although offering almost 100 per cent protection against pregnancy, is associated with many side effects which have resulted in much unnecessary adverse publicity. Such side effects, the majority of which are of annoying nature only, are due to the synthetic hormones used, and have resulted in many changes in formulation and in the withdrawal of several preparations. The types of preparations available are discussed and the side effects appraised from both the patient's and the physician's viewpoint.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Response to short-duration signals, pre- and postmenses, in subjects using oral contraceptives and subjects not using oral contraceptives.

Sixteen female subjects were studied to determine threshold change occurring during and postmenses at thresholds of 1 and 4 kHz for signal durations of 500, 20, and 2 msec. The results indicated that there was no significant difference (p less than 0.05) for the thresholds of 1 and 4 kHz at any duration over the three test times. However, there was a significant second degree trend present at 1 kHz for the 20-msec signal. A comparison was made between the thresholds obtained by nine subjects who were using an oral contraceptive and seven subjects who were not. A significant difference (p less than 0.05) between the groups was found at 4 kHz for the 2-msec signal duration in that the group using oral contraceptives obtained threshold at a lower intensity than did the group not using oral contraceptives.

Acoustic Stimulation↗
PubMed1978

Reduction in incidence of rheumatoid arthritis associated with oral contraceptives. Royal College of General Practitioners' Oral Contraception Study.

Analyses of the frequency of reporting of rheumatoid arthritis have been undertaken as part of the continuing major prospective survey of oral contraceptives. The rate of reporting in oral-contraceptive users (takers) is half of the rate in non-users (controls). The rates for ex-takers and controls are not materially different. The expected rise in the rate of reporting in women over 35 is apparent in controls but suppressed in takers. In the absence of any accountable bias, it is concluded that oral contraceptives protect against the development of rheumatoid arthritis. Although the effect is small, the observation may be valuable in understanding the aetiology of the disease and the mechanism of action of oral contraceptives.

Adult↗
PubMed1977

Mortality among oral-contraceptive users. Royal College of General Practitioners' Oral Contraception Study.

In a large prospective study carried out in the United Kingdom, the death-rate from diseases of the circulatory system in women who had used oral contraceptives was five times that of controls who had never used them; and the death-rate in those who had taken the pill continuously for 5 years or more was ten times that of the controls. The excess deaths in oral-contraceptive users were due to a wide range of vascular conditions. The total mortality-rate in women who had ever used the pill was increased by 40%, and this was due to an increase in deaths from circulatory diseases of 1 per 5000 ever-users per year. The excess was substantially greater than the death-rate from complications of pregnancy in the controls, and was double the death-rate from accidents. The excess mortality-rate increased with age, cigarette smoking, and duration of oral contraceptive use.

Adolescent↗
PubMed1992

Update on oral contraceptive pills and postcoital contraception.

Modern oral contraceptive pills are safe for the majority of American women. The most important contraindications to oral contraceptive pill use are a history of thrombophlebitis or thromboembolism while on the pill or during pregnancy, smoking over 15 cigarettes daily if over 35 years of age, active liver disease, hypertension, diabetes, a lipid disorder, or breast cancer. A history of gestational diabetes is not an absolute contraindication to oral contraceptive pill use, but women with such a history must be encouraged to exercise and eat properly to reduce the high risk of developing overt diabetes. Couples should be encouraged to use condoms to reduce the risk of sexually transmitted diseases. Most antibiotics do not decrease the effectiveness of the pill. Nonuse of contraception among adolescents and older couples is the most common reason for failure. Postcoital contraceptive pills are available but are not completely effective. The use of modern contraceptives is almost always safer than nonuse.

Anti-Bacterial Agents↗
PubMed1992

Noncontraceptive benefits of modern low-dose oral contraceptives.

Most oral contraceptive formulations in current use contain 50 micrograms or less of ethinyl estradiol and 1 mg or less of the various progestins: norethindrone (0.5-1 mg), norgestrel (0.3-0.5 mg), or levonorgestrel (0.05-0.25 mg) [1]. The new generation of progestins--norgestimate, desogestrel and gestodene--are derived from levonorgestrel, the biologically active enantiomer of norgestrel. These steroids have specific metabolic and pharmacologic activity that allow oral contraception at lower doses than previous progestins. Desogestrel and norgestimate are both prodrugs and must undergo hepatic and gastrointestinal metabolism to become biologically active compounds. Gestodene is immediately and completely bioavailable [2]. For the new formulations containing less than 50 micrograms of ethinyl estradiol, the incidence of complications has decreased. With most of the early medical problems identified, current research can now focus on other aspects of oral contraception such as compliance and OC use failure. Prominent noncontraceptive health benefits have been observed in OC users and represent new directions for future research. When the risk-benefit ratio of OC use is evaluated in healthy women today, it clearly favors the benefits. However, these will not be fully realized without an increase in method compliance.

Blood Coagulation↗
PubMed1992

Medical aspects of oral contraceptive discontinuation.

Oral contraceptive (OC) compliance is adversely affected by three medical factors: side effects, poor cycle control, and patients' fears of serious diseases. Most physicians recognize these factors but fail to understand their true impact on continuation rates. In one study, half of current OC users who changed brands and half of former OC users cited unwanted side effects as their reason for discontinuation. Moreover, a substantial number of women discontinue OCs without consulting their physicians. Among the so-called nuisance side effects cited by patients, the most prominent are bleeding irregularities. In new patients just beginning OC therapy, bleeding irregularities such as breakthrough bleeding and amenorrhea can lead to a very high discontinuation rate; as many as 50% of new users discontinue OCs before the end of the first year because of such side effects. OC discontinuation rates among other patient populations vary. The problem has not been studied extensively, but existing data show the problem is a large one. One study involving 550 women of various ages and years of OC use confirmed that cycle control problems led many women to discontinue OC use--often resulting in an unplanned pregnancy. Six percent of the women in this study discontinued OC use because of poor cycle control, and 23% of this group experienced subsequent unwanted pregnancies. In contrast, clinical tolerance with the new progestins such as gestodene is good; in one study 86% of patients had normal bleeding patterns. The principal consequences of poor cycle control are loss of confidence in the OC and the physician, increased anxiety, disruption of sexual relations, additional physician calls and visits, pregnancy tests, discontinuation, and noncompliance. The perception that European women have regarding the pill is that it is a reliable method that does not interfere with sexual activities. However, doubts about the safety of OCs influence compliance with the method. While concerns regarding blood clots have diminished, the fear of cancer is still a concern for many women. The androgenic side effects of weight gain, acne,and breast tenderness are particularly troubling for adolescents, who are sensitive to changes in body image. In one recent study, 20% to 25% of women stopped taking OCs because of weight gain or acne, and another 25% stopped because of fear of cancer. The medical component of improving compliance is the physician's choice of OC. Formulations with low, effective doses of hormones and the fewest side effects should be selected. Cycle control and the side-effect profile are improved with the new progestins.(ABSTRACT TRUNCATED AT 400 WORDS)

Contraceptives, Oral, Combined↗
PubMed1975

Influence of dietary lipids on iron and copper levels of rats administered oral contraceptives.

Interrelationships between oral contraceptives and dietary lipids on iron and copper levels in plasma and tissues were investigated in rats. Diets containing either 20% (by weight) safflower oil or hydrogenated coconut oil with and without cholesterol (0.5%) were fed to weanling, female, Wistar-strain rats for a period of 19 weeks. Three types of oral contraceptive agents differing in estrogen/progesterone ratios were administered during weeks 16 through 19 of the experiment. Control rats received the dietary treatment without oral contraceptives. Hemoglobin concentration, hematocrit, red blood cell counts, mean cell hemoglobin and hemoglobin concentration, and mean cell volume values were similar among the various dietary and drug-treatment groups. Elevated levels of copper were found in livers of drug-treated animals fed diets containing cholesterol and safflower oil, whereas levels of copper or iron in spleen and kidney were not influenced by oral contraceptives. Dietary safflower or coconut oil had no influence on levels of iron or copper in plasma. However, iron levels were higher in liver, spleen, and kidneys of rats fed coconut oil compared with those fed safflower oil. Cholesterol-fed rats had reduced levels of iron in plasma and tissues and increased levels of copper in plasma and liver. Iron deficiency in cholesterol-fed rats was indicated by low levels of iron in plasma, liver, spleen, and kidney. In experiment 2, animals were fed the 20% safflower oil diet, with and without sodium glycocholate or cholesterol, to determine whether the apparent malabsorption of iron resulted from sodium glycocholate or cholesterol. Sodium glycocholate resulted in a marked increase in the absorption of iron, whereas cholesterol depressed absorption.

Animals↗