[Problems with male contraception. 1. Physiological foundations, male contraception (mechanical procedures, contraceptives)].
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Adolescent↗
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Contraceptive practice before and after therapeutic abortion. II. Use-effectiveness of oral contraceptives and intrauterine devices.
Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.
Abortion, Therapeutic↗
Oral contraception, mechanical contraception, and carbohydrate and lipid metabolism: a two-year study.
The carbohydrate and lipid metabolism of 100 women using an oral contraceptive (0.5 mg norgestrel + 0.05 mg ethinyl estradiol) and of 96 women using mechanical contraceptives was monitored over a 2-year period. The women had been screened for factors known to adversely affect carbohydrate and lipid metabolism. Two-hour oral glucose tolerance tests were performed at 6-month intervals during the study; serum insulin was determined at the same intervals in half the women. Triglycerides, total cholesterol, free fatty acids, and body weight were also measured. The study showed no significant differences in lipid metabolism nor in weight gain between women using oral or mechanical contraceptives. After 6 months the fasting glucose of women using oral contraceptives was significantly decreased; at 120 minutes, glucose and insulin levels were significantly increased in comparison to women using mechanical contraceptives. A greater percentage of oral contraceptive users had borderline-abnormal oral glucose tolerance tests but the abnormalities did not persist in the same individuals during the study. The incidence of a pathological oral glucose tolerance with oral contraceptives was 1%.
Body Weight↗
Comparative contraceptive efficacy and mechanism of action of the norgestimate-containing triphasic oral contraceptive.
Norgestimate (NGM), a derivative of 19-nortestosterone with very specific affinity for the progesterone receptor, has been used in combination with ethinyl estradiol (EE) at low doses in both monophasic and triphasic oral contraceptives (OCs). An open-label comparative clinical trial was conducted with 4,234 healthy women using comparative clinical trial was conducted with 4,234 healthy women using triphasic levonorgestrel (LUG)/EE and NGM/EE through a total of 22,312 menstrual cycles. Contraceptive (LUG)/EE and NGM/EE through a total of 22,312 menstrual cycles. Contraceptive efficacy was excellent with both preparations, with no statistically significant between-regimen differences in pregnancy rates. The theoretical Pearl index was the NGM/EE triphasic, and 0.34 for the LNG/EE triphasic. Adverse experiences in groups were typical of those that may occur among women taking low-dose OC agents. was similar with the two preparations: 8.6% for the NGM/EE triphasic and 6.8% for the LNG/EE triphasic. In a separate mechanism of action study, specific endocrine parameters were investigated in 20 subjects using the NGM/EE triphasic for 4 cycles. Ovulation suppression was demonstrated in statistically significant decreases from pretreatment values in serum levels of luteinizing hormone, follicle-stimulating hormone, progesterone, and estradiol. Significant on-treatment increases in serum levels of sex hormone binding globulin evidenced minimal androgenicity. All hormonal values returned to or toward normal in the post-treatment cycle. The study results support those obtained in large noncomparative studies of the NGM/EE triphasic. This phased-dose combination suppresses ovulation and is a very effective, minimally androgenic contraceptive agent with a good safety profile.
Adolescent↗
Contraceptives and the conceptus. I. Chromosome abnormalities of the fetus and neonate related to maternal contraceptive history.
The chromosomes of 3080 products of conception, consisting primarily of newborn infants and medically induced abortions, were examined. These were from 3 major groups of women, those who had used oral contraceptives (primarily the combination types), those who had used nonhormonal contraceptives, and a control group of those who had not used any contraceptives. In the newborn study population, the chromosome abnormality rate was 5.4 per 1000 infants (when cases of proven hereditary involvement are excluded the figure drops to 3.6 per 1000), and in the entire induced-abortion study series it was 7.3 per 1000. These rates are very similar to those obtained in other surveys. The rate of chromosomally abnormal conceptuses increases with increasing maternal age in both the newborn and induced-abortion groups. No statistically significant relationships were found between the observed or age-adjusted rates of chromosome abnormalities and contraceptive history (P greater than .10 in all cases). The findings make it clear that the use of oral contraceptives has no large effect on the risk of having a chromosomally abnormal child although the possibility of a small increase or decrease in this risk, of at most about 10 per 1000, cannot be ruled out because of the small number of abnormalities found.
Abnormalities, Drug-Induced↗
[Hormonal contraception and lipid metabolism. Prospective and retrospective studies of lipid metabolic parameters during the use of contraceptives].
Remarkable changes of several parameters of lipid metabolism were observed in a retrospective study of women, who had used different oral contraceptives for a longer time, in comparison with women without any hormonal contraception. In contrast, under the conditions of a prospective double-blind study no statistically significant alterations of the same parameters were seen under the use of two oral contraceptives different in dosage. Nevertheless, oral contraceptives should not be prescribed to patients with hyperlipidaemia.
Adult↗
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↗
[Changes of the renin-angiotensin-aldosterone system under contraceptive steroids. Contribution to the etiology of hypertension under hormonal contraceptives].
Treatment with hormonal contraceptives leads to a considerable stimulation of the renin-angiotensin-aldosterone-system. First of all, there is a 2,5- to 4fold increase of renin substrate synthesis in the liver. As a consequence, more angiotensin I and angiotensin II are released. Angiotensin II stimulates the secretion of aldosterone in the adrenals, thus producing a higher aldosterone concentration in plasma. The urinary excretion of aldosterone is elevated to a lesser degree, probably because of the simultaneously increased binding of aldosterone to plasma proteins. The release of renin is suppressed to 50% by negative feedback mechanisms. Some possible factors in the etiology of hypertension induced by oral contraceptives are discussed.
Adult↗
High-dose and low-dose combined oral contraceptives: protection against epithelial ovarian cancer and the length of the protective effect. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives.
The relations between use of high-dose and low-dose combined oral contraceptives and epithelial ovarian cancer were compared in an international hospital-based case-control study. 393 cases from seven countries were compared with 2561 matched controls. The odds ratio (OR) was somewhat lower for women who used high-dose oestrogen oral contraceptives (OR = 0.68) than for women who used low-dose preparations (OR = 0.81) although the difference could have occurred by chance. After controlling for time since last use, risk was slightly lower for long-term users of high-dose preparations than for long-term users of low-dose pills. Both high-dose and low-dose oral contraceptives protect against ovarian cancer, but the degree of protection may be slightly weaker for the newer, low-dose products.
Case-Control Studies↗
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↗
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↗
[Definitive contraception and contraceptive responsibility (on the psychic situation in voluntary sterilization in men and women--results of psychologic-psychiatric research) (author's transl)].
Definitive contraception or voluntary sterilization in men and women has become more and more common as a final and permanent contraceptive measure. This family planning method combines all advantages of contraceptives under the psychological prerequisites: independent and free decision, clear motivation regarding the renouncement of reproduction, agreement between the partners, balanced partnership and personality, detailed advice before the operation. These prognostic criteria are derived from the author's evaluation of 73 psychologico-psychiatric series of catamneses of the past five decades in international literature.
Female↗
[Contraception and subsequent fertility. General review on the reversibility of oral contraception].
We have carried out a general review of the problem of reversing the contraceptive mehtods using oestrogen-pregestogen contraceptives. We have very carefully reviewed the onset of long cycles showing clearly that they occur more easily in women who have started with irregular cycles, as do post-pill amenorrhoea cases. Spontaneous abortions seem to occur just as often after the pill as in the general population and the alarm that was raised by D. Carr seems to us to be very exaggerated. The infants are normal, have a lower perinatal mortality when we take into account the patients who use this method and there are no more congenital abnormalities than in other patients.
Abnormalities, Drug-Induced↗
[Problems of male contraception. 2. Male hormonal contraception, post-testicular points of attack, immunization and enzyme inhibition].
In principle control of male fertility is possible by mechanical, surgical and pharmacological methods. However, up to now only the following mechanical and surgical procedures are practicable: coitus interruptus, coitus condomatus and vasectomy. Since the safety of the latter is comparable to the pill, vasectomy is a major alternative to the contraceptive methods used by the female partner. Practical aspects of vasectomy and possible complications are reviewed. Finally, pharmacological approaches and problems involved in the control of male fertility are discussed with special reference to antispermatogenic substances, steroid hormones, immunization and enzyme inhibitors. The concept of antienzymatic contraception is based on the inhibition of penetration of enzymes (acrosin) localized within the acrosomal cap. Unfortunately, penetration of most of the acrosin inhibitors into the acrosome to inactivate acrosin is prevented by the high selectivity of the acrosomal membranes. Thus, pharmacological control of male fertility is still far from being practicable.
Acrosin↗
[Contraception with the Lippes Loop D with or without contraceptive foam (author's transl)].
Contraception with Lippes Loop D was compared in 1 group of women (N 172) who used a spermicidal preparation with intercourse and a second group (N 190) who used no spermicidal preparation. In the group with a Lippes Loop and a spermicidal preparation, there were 1.2% unplanned pregnancies compared to 6.4% unplanned pregnancies without spermicidal preparation. This combined method approaches the reliability of oral contraception. The third group of women who used a spermicidal preparation erratically is not comparable in the statistical sense to the other two groups. However in this third group there were less unwanted pregnancies than in the group without the use of spermicidal preparation.
Contraceptive Agents, Female↗
The contraceptive effects of a new low-dose combination type oral contraceptive.
A study was carried out in 9 women volunteers to investigate the centron of 0.75 mg lynestrenol plus 0.0375 mg ethinyl oestradiol given for 22 days per cycle over a period of 6 cycles. The results of assessments of a number of hormonal, vaginal and cervical parameters showed that this combination has a two-fold effect: a central effect on the pituitary and a peripheral effect on the ovaries and on endometrial development. The findings of an effect on cervical mucus, as with higher dose combinations, were not sufficiently consistent to warrant a claim for a cervical barrier. The preparation appeared to be well tolerated but there was a high incidence of irregular bleeding in the first treatment cycle. In most of the women, however, this had corrected itself by the second cycle.
Adult↗
Steroid contraceptives in non-human primates (II). Metabolic fate of synthetic estrogens in the baboon after exposure to oral contraceptives.
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Animals↗
[Modification of the thrombocyte function using hormonal contraception. 1. Thrombocyte count, thrombocyte propagation and platelet aggregation under hormonal contraception].
The number of platelets, spreading and aggregation of platelets in plasma of 102 women treated with Ovosiston, an anticonceptive agent, were investigated. A significant increase of the number of platelets, spreading and aggregation of platelets was observed. Conclusions from isolated observations are not possible.
Adolescent↗