contraceptives--postcoital and Hypertension

To review new evidence regarding ten controversial issues in the use of contraceptive methods among women with special conditions and to present World Health Organization recommendations derived in part from this evidence.. We searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to ten key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breast-feeding women, tubal sterilization among young women, hormonal contraception and intrauterine device use among women who are human immunodeficiency virus (HIV) positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17 acetate," "norethindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "intrauterine devices," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breast-feeding," "lactation," "age factors," "regret," and "HIV.". From 205 articles, we identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions.. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to nonusers with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk.. Of ten contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly.

Topics: Cardiovascular Diseases; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Evidence-Based Medicine; Female; Headache; HIV Infections; Humans; Hypertension; Lactation; Myocardial Infarction; Progestins; Risk Factors; Stroke

A short review of the endocrinological basis of reproduction in the female is followed by a critical survey of the oral contraceptive methods in current use. The composition of the preparations, their use, their biological and use-effectiveness and mode of action are discussed.The importance is emphasized of complying with the basic principles of drug testing in the evaluation of effects of oral contraceptiveson health. Other effects than merely the contraceptive actions of these preparations are described in detail, including not only the undesirable, frequently neglected, yet very important beneficial effects on the drug-users, their children and families.. Of the oral contraceptives in current use, the most practical and effective are: 1) the combination pill (estrogen and progesterone in various combinations), with a contraceptive effect of almost 100%; 2) 2-phase treatment (estrogen and progesterone administered sequentially), which produces less negative side effects, but is slightly less reliable as an ovulation inhibitor; and 3) the minipill (containing only progesterone), which eliminates any estrogen-induced side effects, but is slightly more complicated as a medication. Continuous treatment with large combination dosages may be tried when complete elimination of menstruation is desirable. The monthly and weekly pills are still being tested. High dosages before or after coitus may be used in certain situations. Clinically undesirable side effects of oral contraceptives include urinary tract infections, fluor vaginalis, moniliasis, hypertension, water retention, lactation changes, and, less frequently, liver and skin disorders and modifications of the carbohydrate metabolism system. These can often be lessened or eliminated by changing to the minipill or to another preparation. A table indicates signs of excessive estrogen or progesterone influence. Extremely serious (sometimes life-threatening) side effects include persistent anovulation, thromboembolic disorders, liver tumors, and severe hypertension. Often the beneficial side effects of oral contraceptives are not mentioned, e.g., improvement or elimination of menstrual disorders, anemia, and acne, and prevention of benign breast and uterine tumors and ovarian cysts. The psychological benefits must also be taken into account. Fear of pregnancy is eliminated and birth control spacing results in improved health for mothers and children.

Topics: Abnormalities, Drug-Induced; Contraceptives, Oral; Contraceptives, Postcoital; Family Planning Services; Female; Humans; Hypertension; Intracranial Pressure; Liver Neoplasms; Population Growth; Pregnancy; Thromboembolism

Topics: Amenorrhea; Biological Assay; Carbohydrate Metabolism; Contraceptive Agents; Contraceptives, Oral; Contraceptives, Postcoital; Estrogens; Eye Diseases; Female; Gonadotropins; Humans; Hypertension; Lipoproteins; Liver; Nandrolone; Neoplasms; Ovulation; Progesterone; Skin Manifestations; Testosterone; Thromboembolism; Transcortin

Over 60 million women use highly efficient and safe modern combined oral contraceptives (OCs) every day. A women who takes the oral contraceptive for 5 years before the age of 30 will actually live 12 days longer, although a woman taking the pill for the 1st time for 5 years after the age of 30 will have her life span reduced on the average by 80 days. OC related morbidity and mortality mostly occur in women over 35 who smoke. Combined low dose OCs are safe for women who do not smoke, at least to 45 years of age and probably to the menopause. The prescription of OCs is also safe to the young adolescent. The pill does not interfere with maturation of the hypothalamic-pituitary ovarian axis and does not increase the incidence of amenorrhoea, oligomenorrhoea or infertility in later life. Patients with contraindications to estrogen therapy are excluded from OC use (history of thromboembolism, major heart disease, liver disease, breast cancer). Low-dose (30-35 mcg estrogen-containing monophasic or triphasic) pills are recommended. Combined oral contraceptives contain either ethinyl estradiol (1.7 to 2 times more potent) or mestranol. After absorption the progestagens, norethisterone acetate, ethynodiol diacetate and lynoestrenol are all metabolized to norethisterone. The progestagen-only pill has about a 2% failure rate and poorer cycle control than the combined pill, but it lacks estrogenic, progestagenic and androgenic side effects. This pill is suitable for the lactating mother, for smokers over 35, for hypertensive patients, and for those with a history of thrombosis. The efficacy of the progestagen-only pill is restored in 3 days of pill taking. Postcoital contraception is an alternative: treatment can be given for at least 72 hours after intercourse. The Yuzpe method calls for the patient to take 2 combined oral contraceptive tablets containing levonorgestrel and ethinyl estradiol (Eugynon or Ovral) followed by a further 2 tablets 12 hours later. This regimen probably reduces the risk of pregnancy about tenfold and it is generally well tolerated.

Topics: Age Factors; Behavior; Biology; Breast Feeding; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Disease; Embolism; Endocrine System; Ethinyl Estradiol; Family Planning Services; Health; Heart Diseases; Hormones; Hypertension; Infant Nutritional Physiological Phenomena; Levonorgestrel; Liver Diseases; Mestranol; Morbidity; Mortality; Norethindrone; Nutritional Physiological Phenomena; Physiology; Population; Population Characteristics; Population Dynamics; Progesterone; Progestins; Smoking; Thromboembolism; Vascular Diseases

Topics: Abortion Applicants; Abortion, Induced; Abortion, Legal; Abortion, Therapeutic; Adolescent; Adult; Congenital Abnormalities; Contraceptives, Postcoital; Female; Fetal Diseases; Heart Diseases; Humans; Hypertension; Kidney Diseases; Mental Disorders; Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, First; Pregnancy Trimester, Second; Radiation Injuries; Socioeconomic Factors

Topics: Behavior; Breast Diseases; Cardiovascular Diseases; Central Nervous System Diseases; Contraception; Contraceptives, Oral; Contraceptives, Postcoital; Diabetes Mellitus; Female; Headache; Humans; Hypertension; Jaundice; Libido; Liver Diseases; Menstruation Disturbances; Mental Disorders; Nausea; Pain; Progestins; Skin Diseases

This is a general review of the types of steroid contraceptives, their mode of action and efficacy, and major complications, including thromboembolism, cancer, jaundice, diabetes and hypertension. Tables show combined and sequential pills available in Belgium, by brand name, manufacturer, and composition. About 300,000 Belgian women use the pill. Since endometrial cancer is probably, and cervical cancer certainly, not enhanced by the pill, the maternal death rate among pill users is about 5% of the rate among unprotected sexually active women.

Topics: Chemical and Drug Induced Liver Injury; Contraceptives, Oral; Contraceptives, Postcoital; Estrogens; Hypertension; Injections; Neoplasms; Progestins; Thromboembolism; Time Factors