A changing pattern in the association of oral contraceptives and the different groups of congenital limb deficiencies

A case-control study on different groups of isolated congenital limb deficiency was performed in a ten-year population-based and revised Hungarian data set. A higher rate of one contraceptive pill type with relatively high dose (ethynodiol diacetate 1.0 mg + ethinyloestradiol 0.05 mg) used in the periconceptional period was found in the mothers of cases with terminal transverse defect (adjusted relative odds 1.9 with 95% confidence interval of 1.1-3.4). This risk is minimised by the use of recent low-dose pills.

Clinical experience with the progestogen-only pill

Experience with the progestogen-only pill (POP) in a family planning clinic is presented. From the clinic records, 408 women were identified who had opted to use a POP. Of these, 50 women had used the POP during lactation and these were excluded from the analysis. The remaining 358 women used the POP for up to 150 months, giving a total of 18,125 women-months of use. Three pregnancies occurred, giving a Pearl Index of 0.2 per 100 women-years. Non-menstrual side effects were minor and were reported by 77 women. For the women who discontinued the POP, the main reason was menstrual irregularity (47.5%). However, despite the long-term use by most of the women, almost 40% maintained a mostly regular menstrual pattern. Our findings suggest that the POP provides a very acceptable method of oral contraception for many women and that it should be more actively promoted.

Oral contraceptives, lipoproteins, and atherosclerosis

A nonhuman primate model was developed to study the effects of oral contraceptives on lipoproteins and atherosclerosis. Cynomolgus macaques were selected because of their susceptibility to diet-induced atherosclerosis and because their reproductive physiology, menstrual cycle, and circulating sex hormone patterns are similar to those of human females. The first study compared a vaginal ring containing levonorgestrel and estradiol with an oral contraceptive containing norgestrel and ethinyl estradiol. A second study compared two oral combinations: norgestrel-ethinyl estradiol and ethynodiol diacetate-ethinyl estradiol. As predicted, use of all the contraceptives led to lowering of high-density lipoprotein cholesterol levels. However, contrary to what might be expected, use of the ethinyl estradiol-containing oral contraceptives did not lead to an increase in the prevalence or extent of atherosclerosis. We concluded that ethinyl estradiol neutralized the atherogenic influence of the progestin component of oral contraceptives.

The varying effects of progestins on lipid levels and cardiovascular disease

A recent study at George Washington University Lipid Research Clinic compared three oral contraceptives containing different progestins and found that increases in total cholesterol, triglycerides, and apoprotein. All were not progestin related. Other effects, however, were apparently dependent on the type of progestin, with the androgenically potent agent dl-norgestrel causing dramatic increases in low-density lipoprotein (LDL)-cholesterol and the ratio of low-density to high-density lipoprotein (HDL) and decreases in HDL, particularly HDL2, and apoprotein Al. Reductions in HDL2 and increases in the LDL/HDL ratio are strongly associated with the development of atherosclerosis. In a study of postmenopausal women receiving hormone replacement therapy, estrogen alone was compared with estrogen plus dl-norgestrel. In contrast to the findings of the previous study, norgestrel lowered LDL and produced less substantial decreases in HDL and HDL2. Thus, although an antiestrogenic effect was evident, it cannot be assumed that the changes associated with progestin-containing oral contraceptives will automatically occur when lower doses of progestin are used in hormone replacement therapy.

Effect of oral contraception by progesterone pill on lipids and glucose metabolism

The influence of oral contraception with 0.5 mg ethynodiol diacetate (Femulen) on blood lipid and glucose tolerance test (GTT) was studied in a group of 14 nulliparous women ages 17-24 years before and 3 months after treatment. In another group of 13 women of matched age, contraception was managed by providing a combined pill (estrogen and progesterone). The continuous treatment of ethynodiol diacetate did not result in the increase in serum cholesterol and triglyceride levels and did not affect the GTT, as observed when the combined pill was administered. Femulen had no side effects, except for 2 cases of vaginal spotting. Ethynodiol diacetate does not induce the decrease in high-density lipoprotein cholesterol levels which is an anti-risk factor for the prevention of accelerated atherosclerotic disease. Oral contraception with this pill is indicated for all women, especially when there is an absolute contraindication for the use of combined pills

Serum and placenta levels of ethynylestradiol in presence of ethynodiol diacetate after oral administration

The ethynylestradiol concentration--in the presence of ethynodiol diacetate--in serum after oral administration was measured by a rapid radioimmunoassay method developed by the authors. It was found that the peak level was reached 1 h after administration, and even after 12 h a significant amount of free ethynylestradiol was present in the serum. The transfer of ethynylestradiol into the placenta was also studied in subjects who were 10-12 weeks pregnant. Placenta/serum quotients were calculated for the ethynylestradiol, and were found to increase in parallel with the dose of the drug administered, proving that an ethynylestradiol enrichment of the placenta occurred as early as 10-12 weeks of pregnancy.

Bioavailability and pharmacokinetics of norethisterone in women after oral doses of ethynodiol diacetate

Measurement by radioimmunoassay of plasma norethisterone (NE) has been used to compare the bioavailability of tablets containing ethynodiol diacetate (EDA) with that of a standard oral solution of this progestogen in 12 normal women. The tablets investigated were from three batches which showed different in vitro dissolution rates. There were no significant differences in the bioavailability of the tablet formulations, which were essentially bioequivalent to the solution. Peak blood levels of NE were reached within 4h of EDA administration in solution or tablets. After the peak, NE plasma levels declined in two phases, with a mean terminal elimination half lives of 4 to 6.9h. The pharmacokinetics of NE after EDA administration showed some similarity to those observed by other workers after oral doses of NE itself.

Factors affecting pituitary gonadotropin function in users of oral contraceptive steroids

In order to determine whether certain factors influence the direct pituitary suppressive effect of contraceptive steroid, 50 subjects who had used various formulations of oral contraceptive steroids for periods of time ranging from one to nine years were stimulated with 50 microgram of gonadotropin-releasing hormone (GnRH) during the last week of oral contraceptive ingestion. The response of lutinizing hormone (LH) and follicle-stimulating hormone (FSH) was compared to the results obtained in nine control subjects with regard to: (1) age of subject. (2) type of contraceptive formulation used, and (3) length of use. Prestimulation levels of LH and FSH, respectively, were significantly decreased in 37 (74 per cent) and 42 (84 per cent) of the subjects. Following GnRH stimulation, peak responses of serum LH and FSH, respectively, were also significantly lower than those in the control subjects in 40 (80 per cent) and 45 (90 per cent of the subjects. The degree of suppression of pituitary gonadotropins, both before and after GnRH administration was significantly correlated with the type of steroid formulation used, being greatest with a combination of d-norgestrel and ethinyl estradiol. No correlation was found with length of use of oral contraceptives or age of the subjects.

Mesenteric venous thrombosis associated with oral contraceptives: a case report

Small-bowel infarction resulting from mesenteric venous thrombosis is a rare but life-threatening complication to which young women taking oral contraceptives are liable. The patient characteristically presents with an "acute abdomen" after a variable prodromal period of vague abdominal pain. The correct diagnosis can be made from the macroscopic appearance at laparotomy, provided the surgeon is alert to the condition. An accurate diagnosis is important, as anticoagulation measures must be instituted early to counter the commonly associated thromboembolic phenomena.