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Advantages and disadvantages of low-dose oral contraceptives.

Whenever a medication is prescribed, the lowest effective dose should be selected when possible. This recommendation is particularly important when oral contraception is being considered. In the years since the pill became available, there has been a steady decline in the dosages used. Contemporary "low-dose" varieties are those containing less than 50 micrograms of estrogen. Although they provide equal reliability, low estrogen formulations contain only a fraction of the quantities used in the original varieties. Subjective side effects are reported far less frequently with lower dose pills, and metabolic effects are reduced. The only associated disadvantage is a tendency to more spotting and breakthrough bleeding in early cycles. No matter how low the dose, there will always be some women for whom this method is not suitable. Fortunately, the progestogen-only pill--a consideralby underused contraceptive measure--can often be highly acceptable.

Body Weight↗
PubMed1977

Low-dose combination oral contraceptives: a controlled clinical study of three different norgestrel-ethinyl estradiol ratios.

Three doses of norgestrel-ethinyl estradiol in altered ratios were investigated in a double-blind, randomized study. The estrogen content was maintained at 20 microng or less, while the progestogen dose was increased in 100-microng increments. Two pregnancies were reported for the lowest dose. No pregnancies occurred in the two higher doses. Each dosage increase improved cycle control and lessened bleeding irregularities. The incidence of patients reporting intermenstrual bleeding was inversely proportional to the doses studied. Dropouts for cycle disturbances followed a similar pattern.

Adult↗
PubMed1979

A randomized double-blind trial of two low dose combined oral contraceptives.

Fifty-five women using Loestrin-20 (20 microgram ethinyl oestradiol and 1 mg norethisterone acetate) as an oral contraceptive have been compared with a like number using Microgynon-30 (30 microgram ethinyl oestradiol and 150 microgram levonorgestrel) in a randomized, double-blind trial. Despite the small sample size, the main finding in the trial is clear-cut; Loestrin-20 provides poor cycle control and is thus less acceptable as an oral contraceptive than Microgynon-30. Although there is also a suggestion that Loestrin-20 may be less effective than Microgynon-30, the difference in the accidental pregnancy rates is not statistically significant.

Adolescent↗
PubMed1976

[Histochemical and histological investigations on the human fallopian tube under different hormonal influences. I. Demonstration of ATPase with special reference to reactive ciliated cells (author's transl)].

The localization of the Mg++-activated adenosine triphosphatase (ATPase) in the human Fallopian tube has been studied by means of histochemical methods. The samples were obtained from 18 women in the age from 23--62 years. Some of them were treated by various steroid hormones. Endosalpinx ciliary ATPase-activity represents dynein and is therefore an indicator of ciliary motility. Estrogens and gestagens have a different influence on the ATPase-activity. All cilia of one ciliated cell react in the same manner and may be regarded as a reaction unit. The relation of negative to positive ciliary borders differs characteristically in the tubal isthmus, ampulls and infundibulum and coincides with commonly known phenomena of egg transport through the oviduct. Postovulatory, reaction units increase in ampulla and infundibulum compared with the proliferative phase. The oviducts of postmenopausal women possess but a scanty outfit of reaction units. Short-time treatment with estrogen in the early secretory phase results in a great number of reaction units in all tubal segments; a similar treatment in the proliferative phase diminishes the reaction units in the ampulla. Midcycle progesterone treatment activates the ciliary ATPase in the isthmus. Low doses of lynestrenol (minipill) in the proliferative phase leads to a decrease of reaction units in all tubal segments; the pattern of ciliary reaction under low doses of lynestrenol at the time of ovulation coincides with that of the proliferative phase. Treatment with a contraceptive steroid (0,05 mg ethinylestradiol and 0,25 d-norgestrel) causes a considerable activation of the ciliary ATPase in all portions of the oviduct.

Adenosine Triphosphatases↗
PubMed1978

'Patient failure' as a reliability model for the 'minipill': a clinical study.

A trial was carried out in 10 healthy women to study the effects of withdrawal of treatment with 0.5 mg lynestrenol per day, for 3 successive days during the pre-ovulatory phase, on the physiological properties of the cervical mucus, vaginal cytology and pituitary and ovarian functions. In most cases, the amount, Spinnbarkeit and ferning of the cervical mucus and sperm penetration remained the same as that before interruption of treatment. In 2 women, the ferning altered to 'good' for 2 to 3 days as the amount of mucus increased slightly. Spinnbarkeit increased at the same time and sperm penetration was good. The changes in LH and FSH excretion suggested that ovulation possibly took place in 1 of the women studied. A mid-cycle oestrogen peak was seen in 2 women. No side-effects were reported during the study apart from irregular intermenstrual bleeding in 1 woman.

Adult↗
PubMed1977

Epidemiology of venous thromboembolism.

This review of the epidemiology of venous thromboembolism includes estimates of incidence and prevalence of venous thrombosis and its sequelae, a discussion geographical, annual and seasonal variations and data concerning possible risk factors. Selection of patients at increased risk for development of deep venous thrombosis or pulmonary embolism for specific diagnostic screening or for prophylactic therapy with low-dose heparin may be a more effective approach to lowering morbidity and mortality from this disease.

Adult↗
PubMed1976

The effect of treatment with a low-dose progestagen (Lynestrenol) on hormonal cytology.

The effect of continuous, low-dose progestagen therapy on endogenous oestrogen production and ovulation in women, was investigated in terms of vaginal cytology. The phase contrast method was used to establish the karyopknotic index from 482 smears from patients using lynestrenol 0.5 mg for oral contraception. The results are presented as the mean of karyopyknotic indices, with standard deviation and standard error of the mean, scored over each three day period of the menstrual cycle, and, in the case of delayed menstruation, over longer periods throughout the protracted cycle. Graphically, the results are shown as average levels compared to controls. Our results show that in patients who have used the preparation for a maximum of three months, cyclic oestrogen production varies only slightly, the mean being within the lower limit of normal and suggesting FSH suppression. In patients who use the preparation for longer periods, the karyopyknotic index becomes similar throughout the cycle to that of controls, being clearly biphasic and generally suggestive of ovulation. In the first group, delayed menstruation seems to be caused mainly by transient FSH suppression. When it occurs in the group treated over a longer period, the disorder appears to be caused by a normo- or hyperoestrogenic, anovulatory condition, due initially to LH suppression with FSH supression setting in later, if the disorder persists longer.

Adult↗
PubMed1977

[Clinical findings with a low-dosed antiandrogene (cyproteronacetate) and aethinyloestradiol women with virilising symptoms (author's transl)].

The paper refers to 167 patients who were treated with 2 mg Cyproteronacetate and 50 mug Ethinyloestradiol because of acne, seborrhoea, hirsutism and androgenetic alopecia. The application was daily from the 5th to the 25th day of cycle over a period of 12 months. The success of treatment depended on the severity of virilisation: in cases of light acne only 77% of the patients showed improvement, while in cases of severe acne 91,4% showed improvement or healing of acne. The corresponding figures for seborrhoea were 55,7% and 89,4% respectively, and for hirsutism 37,4% and 60,9% respectively. Furthermore the success of treatment of the different virilising symptoms depended on the duration of therapy: while acne was already cured significantly after 6 months of treatment, seborrhoea and hirsutism show continuous improvement up to the 10th month thetherapy. Concerning side effects during therapy spottings and brake through bleedings were registered in 17,1 and 6% of cycles respectively. 16,2% of the patients noted breast tensions. Finally 68,7% of the patients suffered from nervousness, a very subjective symptom, which might be explained by the psychic lability accompanying virilising symptoms. The drop out rate was 7,8%, being not higher than with other oral contraceptives.

Acne Vulgaris↗