contraceptives--postcoital and Thromboembolism

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: Abnormalities, Drug-Induced; Arrhythmias, Cardiac; Breast Neoplasms; Contraception; Contraceptive Devices; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Estradiol Congeners; Female; Humans; Intrauterine Devices; Lactation; Male; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Progesterone; Progesterone Congeners; Prospective Studies; Spermatocidal Agents; Thromboembolism; Time Factors; Uterine Cervical Neoplasms

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

Topics: Animals; Carcinoma; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Corpus Luteum; Embryo Implantation; Female; Humans; Intrauterine Devices; Lactation; Male; Medical Laboratory Science; Methods; Ovulation; Ovum; Pelvic Inflammatory Disease; Pheromones; Pregnancy; Progestins; Semen; Spermatogenesis; Spermatozoa; Sterilization, Reproductive; Technology, Pharmaceutical; Therapeutic Irrigation; Thromboembolism; Uterine Cervical Neoplasms

Postcoital contraceptive pills (PCP) have recently been approved for use as emergency contraception in the United States. The objective of this study was to assess the risk of idiopathic venous thromboembolism (VTE) in relation to exposure to PCP, and to better quantify the risk of idiopathic VTE associated with current oral contraceptive (OC) use and pregnancy. A population-based cohort study with a nested case-control analysis was conducted using women from the General Practice Research Database. There were no women with an outcome of idiopathic VTE with current exposure to PCP. The incidence rates for various exposures were 3.0/100,000 person-years for the unexposed, 5.3/100,000 person-years for second generation OC, 10.7/100,000 person-years for third generation OC, and 15.5/100,000 person-years in pregnant (or postpartum) women. The relative risk estimates were 1.7 (95% CI 0.3-10.5) for second generation OC, 4.4 (95% CI 1.0-18.7) for third generation OC, and 6.3 (95% CI 1.2-33.5) for pregnancy. Short-term use of PCP is not associated with a substantially increased risk for developing VTE.. A population-based cohort study with a nested case-control analysis was conducted to assess the risk of idiopathic venous thromboembolism (VTE) in relation to exposure to postcoital contraceptive pills (PCP) and to better quantify the risk of idiopathic VTE associated with current oral contraceptive (OC) use and pregnancy. The subjects were women less than 50 years of age who received PCP prescriptions at some time between January 1, 1989, and October 31, 1996. All subjects in the cohort of PCP users had a computer-recorded diagnosis from the General Practice Research Database. The results of the study indicate that there were no women currently exposed to PCP who had an outcome of idiopathic VTE. The incidence rates for various exposures were 3.0/100,000 person-years for those unexposed, 5.3/100,000 person-years for second-generation OCs, 10.7/100,000 person-years for third-generation OCs, and 15.5/100,000 person-years for pregnant (or postpartum) women. The relative risk estimates were 1.7 (95% CI, 0.3-10.5) for second-generation OCs and 4.4 (95% CI, 1.2-33.5) for pregnancy. Thus, the risk of VTE attributable to PCP is not substantially higher than it is for the risk for traditional OCs, despite the higher content of both estrogen and progesterone present in PCP.

Topics: Adult; Age Factors; Case-Control Studies; Cohort Studies; Contraceptives, Postcoital; Databases as Topic; Family Practice; Female; Humans; Middle Aged; Pregnancy; Risk; Risk Assessment; Smoking; Thromboembolism; United Kingdom; United States; Venous Thrombosis

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

Plasma antithrombin III (AT III) was studied longitudinally in 15 subjects (13 patients and 2 volunteers), who used the "morning-after pill" (5 mg ethinylestradiol daily for 5 days). The mean decrease in AT III level in the 13 patients was 17% of the pre-treatment value. From additional observations made in 2 of the patients and in the 2 volunteers it is concluded that this decrease is caused by hemodilution due to salt and water retention rather than by a decreased synthesis or increased consumption.

Topics: Adolescent; Adult; Antithrombin III; Contraceptives, Postcoital; Ethinyl Estradiol; Female; Humans; Thromboembolism

An overview of modern contraceptive methods in Finland is presented. Pincus began his work on hormonal contraceptives in 1951. The first oral contraceptives (o.c.s) contained high hormone dosages, up to 200 mg estrogen. Side effects of o.c. use were reported, the most serious being thromboembolic disease. Presently, ethinyl estradiol and mestranol are the estrogens used in producing o.c.s. After 1974, the estrogen dosage was reduced to 30-50 mg, but a higher incidence of thromboembolic disease was still associated with women who smoked or older women who used o.c.s. Mini-pills were developed at the end of the 1960s. Mini-pills were found to be somewhat less effective and more frequently cause menstrual bleeding irregularities, but they did not cause any serious side effects. Injectable preparations consisted of synthetic progestins which were injected every 3-7 months. Such preparations were often associated with menstrual bleeding irregularities and difficulties in controlling the hormone dosages. This caused an increase in the incidence of pregnancy as the length of time after the injection increased, or caused infertility for periods after the use of the injection preparations was discontinued. Tests are being done on subdermal capsules, which release progestins in controlled amounts, vaginal rings which release d-norgestrel and ethinyl estradiol, and IUDs which release progesterone and have a localized effect on the myometrium. Tests are also being performed on "morning after pills" which consist of hormones with a luteolytic effect which inhibit nidation. Although the low-dosage combination preparations are presently the most effective contraceptive method, the new types which are being tested may replace them some day.

Topics: Contraceptives, Oral; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Contraceptives, Postcoital, Hormonal; Delayed-Action Preparations; Drug Implants; Female; Humans; Thromboembolism

Topics: Allyl Compounds; Contraceptives, Oral; Contraceptives, Postcoital; Estradiol Congeners; Estrenes; Estrogens; Female; Humans; Hydroxysteroids; Menstruation; Ovary; Progesterone Congeners; Thromboembolism; Time Factors

Topics: Blood Pressure; Carbohydrate Metabolism; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Diethylstilbestrol; Female; Humans; Intrauterine Devices; Lipid Metabolism; Male; Medroxyprogesterone; Neoplasms; Pregnancy; Prostaglandins; Thromboembolism

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

Topics: Body Temperature; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Delayed-Action Preparations; Dose-Response Relationship, Drug; Female; Humans; Intrauterine Devices; Ovulation; Patient Care Planning; Periodicity; Prostaglandins; Thromboembolism; Uterine Cervical Neoplasms