The effect of progestogens on vaginal cytology

Various progestogens were given to postmenopausal and premenopausal women. The first group consisted of 46 postmenopausal patients and in the postmenopausal atrophic smear, 17 acetoxyprogestogens produced no effect. However, the administration of two 19 nortestosterone derivatives, ethynodiol diacetate and norethisterone increased the Karyopyknotic Index and degree of proliferation of the epithelium, presumably due to their estrogenic metabolites. Low grade hypotrophic smears, consisting of parabasal and intermediate cells, reacted by a decrease in the size of the intermediate cells associated with clumping, and a disappearance from the smear of parabasal cells. In the case of ethynodiol diacetate, its estrogenic effect of elevating the Karyopyknotic Index occurred before the progestogenic effect of clumping and fusing of the intermediate cells. The second group consisted of 370 women using an oral form of sequential contraception, based on administration of 0.05 mg ethinyl estradiol daily for three weeks followed by a combined oral contraceptive containing the same amount of estrogen with varying progestogens for a further week. The anti-estrogenic effect of the various progestogens was then compared by their ability to lower the Karyopyknotic Index. This levelled out after four or five tablets. The most potent progestogen was d-norgestrel in the lowest dose of 0.25 mg and this compound exerted a greater effect than 4 mg norethisterone, 1 mg ethynodiol diacetate or 4 mg megestrol acetate.

[Estroprogestational drugs and the ultimate embyogenesis in the rat]

Cyclic female rats were fed with ethinodiol diacetate plus mestranol (EDM) for periods of 45 to 180 days. They were mated during prooestrus, on the first cycle following the end of the treatment. Results were as follows: 1. The cycle is blocked about eight days after starting E.D.M. The longer the treatment, the later rats resume their cycle. 2. Degeneration of the ova before implantation and embryonic mortality are slightly augmented when fecundation takes place within two days after stopping E.D.M.; whereas from the third cycle on, the quality of th ova is identical to the control group. The ova are euploid; they are more fragile to hypotonic shock than the ova of the control animals. No influence of E.D.M. upon meiotic or mitotic processes could be demonstrated. Those experiments do no allow any inference to the human species, but they are inkeeping with the observations of Boué et al. on women.

Effect of ethynodiol diacetate and combination--type oral contraceptive compounds on carbohydrate metabolism. I. Six month intravenous glucose tolerance study

In order to evaluate long-term effects of different types of oral contraceptive compounds, blood glucose and plasma insulin levels were measured during an intravenous glucose tolerance test in 2 groups of normal, nondiabetic patients: 36 women using a progesterone-alone oral contraceptive, ethynodiol diacetate, and 36 women using a combination-type drug, containing norethynodrel and mestranol. Each patient was tested before and after 6 months of treatment. There were no significant differences from pre-treatment glucose and insulin values in the first group of women (on ethynodiol diacetate). In the second group (on norethynodrel and mestranol), there was a significant elevation of mean blood glucose levels at 15, 30 and 120 min of the glucose tolerance test. Nevertheless, a significant elevation of plasma insulin was seen only at 60 min of the test. Patients participating in this study will continue this treatment, and monitoring of carbohydrate metabolism is contemplated over a period of several years.

The effect of combination and low dose progestogen oral contraceptives on serum lipids

Fasting serum triglyceride, free fatty acid, phospholipid, and cholesterol levels were determined in women who were taking either combination or low dose progestogen oral contraceptives. The contraceptives used were: ethynodiol diacetate and ethynyl estradiol; norgestrel and ethynyl estradiol; norgestrel; and megestrol acetate. Serum lipids significantly increased in women taking combination pills. They significantly decreased in patients taking norgestrel, while they remained almost unchanged in patients taking megestrol acetate. This decrease varied with the type of progestogen used in continuous low dosage therapy. The confusion when interpreting the results from different reports on the effects of oral contraceptives on serum lipids will be reduced if proper attention is given to the types of steroid used.

Estrogen potency of oral contraceptive pills

The estrogen potencies of 9 oral contraceptive pills, Enovid-E, Enovid-5, Ovulen, Demulen, Norinyl+80, Norinyl+50, Ovral, Norlestrin 1 mg. and Norlestrin 2.5 mg., were determined by bioassay. Relative estrogen potency was determined by analysis of variance. Enovid-5, the most estrogenic compound, had a potency of 4.88 compared to ethinyl estradiol, 50 mcg. equal 1.00; Ovral, the least estrogenic compound, had a potency of 0.81, a sixfold difference. Estrogen potencies at a fractional dose of 0.00155 correlate with reports of the incidence of minor side effects and thromboembolic disease. The effect of progestins on estrogen potency was purely additive (norgestrel and norethynodrel), purely antagonistic, or additive at low concentrations and antagonistic at high concentrations (norethindrone, norethindrone acetate, and ethynodiol diacetate). These results suggest that pills with a greater margin of safety might be developed by utilizing greater ratios of progestin to estrogen. In addition, differences in relative estrogen potency of oral contraceptive pills may be used as a basis for better clinical selection.