Further investigations on the cytological effects of some contraceptives

Anovlar induces a mitodepressive effect, producing abnormal prophases and a considerable number of micronuclei, i.e. Anovlar can produce major cytological abnormalities. On the other hand, Lyndiol induces minor abnormalities leaving the process of mitosis to proceed almost normally. Microgynon 30 did not show any effect on any of the mitotic stages. Our conclusion may offer an explanation for the contradictory results found in the literature upon the cytological effect of oral contraceptives, although the major chemical constitution of all contraceptives used is the same, still there are minor differences in their chemical structure. These minor differences in chemical structure may be the deciding cause whether or not a contraceptive is harmful.

[Inner ear disturbance following long-term usage of hormonal contraceptives (author's transl)]

Four cases of either unilateral or bilateral irreversible hearing loss are reported in young women following long-term usage of hormonal contraceptives. Two different forms of the hearing disturbance and their causes are described, taking into consideration related neurological, medical and ophthalmologic literature. From this material, guidelines for clinical practise are proposed.

Focal nodular hyperplasia of the liver and contraceptive steroids

A case of Focal Nodular Hyperplasia of the liver in a young woman taking oral contraceptives is described. The parenteral administration of an elevated dosage of progesterone in a concentrated period of time is a remarkable feature of this case. The vascular alterations, which consisted of a marked increase of arterial and venous formations, intimal proliferation, diffused thrombosis, and the presence of large blood spaces recalling "peliosis hepatis" are the most salient microscopic findings. We should not exclude the possibility that these peculiar vascular alterations be the real effect of steroid hormones on a pre-existent hepatic lesion.

[Clinical aspects of a new, very low dose combination contraceptive]

In a multicentre trial in Yugoslavia 150 fertile women were treated during 2541 menstrual cycles with Ovoresta M, a new low-dosed combined oral contraceptive pill. Each tablet contains 0.75 mg lynestrenol and 0.0375 mg ethinyloestradiol. Evaluation of the results shows that there were no pregnancies. Irregular bleedings occurred in 8.1% of all cycles. The side effects recorded were mainly due to the fact that for 140 of the 150 participants this was the first oral contraceptive they ever used. 2 women dropped out for relevant reasons (irregular bleedings). Because of the low dosage of active ingredients the authors consider Ovoresta M a welcome supplement to the existing oral contraceptives.

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.

[The effect of low dose gestagens on the hypothalamic-pituitary-ovarian axis]

The contraceptive effect of continuous treatment with low dose progestogens (minipill) has been attributed mainly to alterations of the cervical mucus and the endometrium. This study was undertaken to investigate the effect of low dose progestogens on hypothalamic-pituitary-ovarian function. Plasma concentrations of follicle stimulating hormone (FSH), luteininzing hormone (LH), estradiol-17 beta (E-2) and Progesterone were measured daily during apparently ovulatory menstrual cycles and during treatment cycles with different low dose progestogens. From the results obtained it was concluded that the minipill has a clear-cut effect on the LH/FSH peak at midcycle and on corpus luteum function. A cyclic secretion of E-2 is maintained in the majority of cases. In a few treatment cycles however, follicular maturation was suppressed as indicated by low E-2 concentrations. It was concluded that the minipill exerts a profound effect at the central and ovarian level which contributes to its satisfactory contraceptive efficacy.

Comparison of ethinylestradiol and mestranol in sequential-type oral contraceptives in their effects on blood glucose and serum insulin in oral glucose tolerance tests

Forty 3-hour oral glucose tolerance tests (OGTTs) were performed in 10 assumedly healthy female volunteers 19 to 30 years old, each serving four times as her own control. Each subject was taking a sequential type oral contraceptive containing either 50 microgram of ethinylestradiol or 80 microgram of mestranol alternatingly in four consecutive treatment cycles. The OGTTs were performed on the 6th day of each cycle, during pure estrogen medication. Blood glucose and serum insulin values did not differ significantly under either estrogen as tested by the t-test for paired observations. Our results do not support the findings of others that mestranol has a more pronounced or even exclusively adverse effect on glucose tolerance as compared with ethinylestradiol.

[Central and peripheral actions of an oral contraceptive with reduced oestrogen content (author's transl)]

The action spectrum of an oral contraceptive which contained a reduced amount of the oestrogen component (0.04 mg ethinyl-oestradiol and 2.0 mg lynoestrenol) was investigated in 4 volunteer subjects. Serum levels of LH, 17 beta-oestradiol and progesterone were determined by radioimmunoassay and, in addition, the karyopyknotic index and cervical function were studied daily from the 8th day of the cycle. These parameters were determined in a control cycle, in the cycle during administration of the oral contraceptive and in the subsequent treatment-free cycle. Furthermore, the bleeding patterns were studied in 284 treatment cycles of 26 patients. Results of these studies indicate complete contraceptive protection by inhibition of ovulation and by an efficient cervical barrier action already during the first treatment cycle. Withdrawal bleeding was observed 3 to 4 days after ingestion of the last tablet. Spotting was recorded in 11 subjects during the first treatment cycle but was rarely observed during further treatment. Blood loss and bleeding control is comparable to that of other combined oral contraceptives with reduced oestrogen content.

[Histochemical and histological investigations on the human fallopian tube under different hormonal influences. I. Demonstration of ATPase with special reference to reactive ciliated cells (author's transl)]

The localization of the Mg++-activated adenosine triphosphatase (ATPase) in the human Fallopian tube has been studied by means of histochemical methods. The samples were obtained from 18 women in the age from 23--62 years. Some of them were treated by various steroid hormones. Endosalpinx ciliary ATPase-activity represents dynein and is therefore an indicator of ciliary motility. Estrogens and gestagens have a different influence on the ATPase-activity. All cilia of one ciliated cell react in the same manner and may be regarded as a reaction unit. The relation of negative to positive ciliary borders differs characteristically in the tubal isthmus, ampulls and infundibulum and coincides with commonly known phenomena of egg transport through the oviduct. Postovulatory, reaction units increase in ampulla and infundibulum compared with the proliferative phase. The oviducts of postmenopausal women possess but a scanty outfit of reaction units. Short-time treatment with estrogen in the early secretory phase results in a great number of reaction units in all tubal segments; a similar treatment in the proliferative phase diminishes the reaction units in the ampulla. Midcycle progesterone treatment activates the ciliary ATPase in the isthmus. Low doses of lynestrenol (minipill) in the proliferative phase leads to a decrease of reaction units in all tubal segments; the pattern of ciliary reaction under low doses of lynestrenol at the time of ovulation coincides with that of the proliferative phase. Treatment with a contraceptive steroid (0,05 mg ethinylestradiol and 0,25 d-norgestrel) causes a considerable activation of the ciliary ATPase in all portions of the oviduct.

Effects of contraceptive pills and intrauterine devices on urinary bladder

The incidence of bacteriuria and cystoscopic changes in women on oral contraceptives or users of IUD (intrauterine devices) were evaluated compared with a control group. Subjects with bacteriuria accounted for 40.5 per cent of pill users, 20 per cent of women fitted with IUD, and 16 per cent of the control group. Bladder trabeculations were found in 50.5 per cent of the pill group, 8.7 per cent of the IUD group, and 8 per cent of the controls. Congested bladder trigone was observed in 24.6 per cent of women fitted with an IUD. The mode of action of ovarian hormones and their possible side effects on the bladder are discussed. The relation of IUD to pelvic inflammatory disease and its effect on the urinary bladder are evaluated.

[The low dosis gestagen therapy (author's transl)]

In young women aged 22-34 years the hormone profile under continuous therapy with 0.5 mg lynestrenol/day have been investigated. Estradiol, progesterone and FSH values have been determined in plasma by the RIA or protein-binding method, whereas LH excretion was daily measured in the urine starting on the 5th day of cycle. The low-dose-gestagen therapy shows all possible hormonal patterns ranging from the ovulatory to anovulatory one. The estradiol-17 B values in half of the patients were higher than in the cycle preceding treatment. In the first few treatment cycles all women showed markedly decreased progesterone values. However, this defect seems to recover and return to normal in later cycles. In order to be able to further explain the alterations occurring during the luteal phase under the treatment with 0.5 mg/day of lynestrenol, ovarian tissues wedge resection of women undergoing gynecological surgery has been examined macroscopically and microscopically. At the same time the hormonal profile has been determined in plasma. These investigations revealed that the morphological alterations in the ovary proceed in an unchanged way under the mentioned treatment. Histologically it could be demonstrated that ovulation is delayed by several days. The histological findings of tubal tissue (from patients who underwent sterilization) showed that the secretional activity of the tubal epithelium is considerably decreased and ciliogenesis increased. In our clinical study neither tablet nor patient failures occurred. With the exception of cycle- and tempo-disturbances no severe adverse reactions were reported. Breakthrough bleedings and spotting as well as amenorrhea in most cases manifested already in the first treatment cycles. It is important that the daily tablet is taken at midday because the maximum effect on the cervical mucus of the mini-pill therapy is most pronounced 4-6 hours after tablet intake. Especially in young patients it is recommended to get written reports on tablet intake. The strict following of these directions mainly guarantees a successful mini-pill therapy.

Lack of influence of the phase of estrus cycle or treatment with steroid contraceptive drugs on cholinergic parameters in mouse and rat brain

Acetylcholine and choline levels were found not to fluctuate with the phase of the estrus cycle in the cerebral hemispheres, deincephalon and mesencephalon in the rat and mouse. Choline acetyltransferase activity was not altered in these brain areas in the mouse while in the rat there was a small but significant decrease in the cerebral hemispheres during proestrus (p less than 0.01), and in the mesencephalon during estrus (p less than 0.05), both with respect to diestrus. Chronic 30-day treatment with steroid contraceptive drug combinations (lynestrenol, 5 mg/kg+ mestranol, 0.3 mg/kg; lynestrenol, 2.5 mg/kg+ mestranol, 0.15 mg/kg; norethindrone, 4 mg/kg+ mestranol, 0.2 mg/kg; norethynodrel, 4 mg/kg+ mestranol, 0.06 mg/kg) did not alter cholinergic parameters in the brain areas of these two species except for minor changes in rare instances.

Modifications of striatal dopamine levels by steroid contraceptive drugs in mice and rats

The effect of steroid contraceptive drugs (SCDs) on the concentration of dopamine (DA) in the striatum was studied in mice and rats. Mestranol was combined with each one of the three progestins, lynestrenol, norethindrone and norethynodrel. Treatments were given daily for 1, 4 or 30 days; animals were sacrificed 1 or 18 h after the last administration. In all groups, with the exception of the animals sacrificed 1 h after an acute treatment, striatal DA was significantly lower than in controls.

Biochemical effects of treatment with oral contraceptive steroids on the dopaminergic system of the rat

The effects of acute and chronic administration of a combination of lynestrenol-mestrenol, a widely employed contraceptive medication, on the dopaminergic system of the rat forebrain and striatum were investigated to better understand the biochemical basis of the neurological side-effects of steroid contraceptive drugs (SCDs). Both acute and chronic treatment increased the disappearance rate of striatal dopamine (DA) after synthesis blockade with alpha-methyl-p-tyrosine (alpha-MpT). Moreover, the conversion of 3H-tyrosine (3H-T) into 3H-DA was increased in the forebrain and striatum after chronic administration of this steroid combination. In the same animals, the utilization of tyrosine (T) is increased.

Malignant hypertension with irreversible renal failure due to oral contraceptives

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[Influence of hormonal contraceptives upon carbohydrate metabolism in women with abnormal glucose assimilation during previous pregnancy (author's transl)]

Carbohydrate metabolism was examined--by means of the 100-gm-glucose standard tolerance test--in 23 patients showing a decrease in glucose tolerance during pregnancy; the examinations were carried out postpartum and after a three months' intake of a hormonal contraceptive (compound preparation: mestranol 0.1 mg, lynestrenol 1.0 mg). The peak values and the two-hour-values, being statistically significant, showed a normalization after delivery, and furthermore again a deterioration of glucose tolerance during the intake of the preparation. A remarkable increase in weight, as a possible cause for the dysbolism during contraception, was not observed.

Studies on the mechanism of the ovulation-inhibiting effect of 19-norsteroids in cyclic rats

Experiments performed in cyclic female rats demonstrated an equal ovulation-inhibiting activity of the 19-norgestagens norethynodrel, lynestrenol and norethisterone acetate after injection in oestrus and metoestrus, and after daily administration from oestrus to pro-oestrus. The results furthermore show that, after application of the minimal ovulation-inhibiting doses during oestrus and metoestrus, these substances 1. induce an increase in prolactin secretion, 2., with the exception of norethisterone acetate, possess a hypophysial site of action, 3. are able to induce deciduoma formation following traumatization of the uterus, and 4. maintain the reactivity of the cyclic corpora lutea to the injection of prolactin. The findings suggest that the prolactin-releasing and luteotrophic action of the progestagens studied may form an essential part of the mechanisms that are responsible for the inhibition of ovulation observed in rats after administration over one cycle.

A clinical impression of a combination-type contraceptive: Neo-Lyndiol

One hundred and sixty-five women were treated during a total of 3,281 cycles with Neo-Lyndiol, a combined oral contraceptive containing 2·5 mg lynestrenol and 0·050 mg ethinyloestradiol per tablet. The tablets were taken for 32 days, with six tablet-free days.

No pregnancies were seen and the proportion of patients experiencing irregular bleeding and side-effects was very low and in fact their complaints decreased considerably as medication continued. There was a drop-out rate of only 5·5%, which is exceptionally low.

Neo-Lyndiol proved to be a reliable preparation, controlling the cycle well and causing few side-effects.

Urinary hormone excretion patterns during low-dose progestogen administration

The effects on pituitary-ovarian function of long-term administration of 0·5 mg of lynestrenol and 0·35 mg of norethisterone in continuous daily doses were investigated in 9 female subjects. The parameters employed were the basal body temperature charts and urinary assays of LH, total oestrogen and pregnanediol.

At the start of administration, ovulation was usually inhibited, but as a rule this effect disappeared as administration continued. Corpus luteum function appeared to be reduced.

Clinical evaluation of a new oral contraceptive, 'Pregnon'

'Pregnon', a new oral contraceptive containing 1 mg. lynestrenol and 0.05 mg. ethinyl oestradiol, was administered cyclically to 639 women of fertile age over a total of 9,159 cycles. There were no pregnancies. In most cases the withdrawal bleeding resembled normal menstruation. The incidence of metrorrhagia was relatively low and when it did occur it was usually confined to the early treatment cycles and was of very limited duration. The objective and subjective tolerance was excellent.

Effect of selective lesioning of brain serotonin or catecholamine-containing neurons on the activity of oral steroid contraceptives in rats

The effect of different dosage combinations of lynoestrenol and mestranol were studied in rats that have been subjected to selective lesioning of brain serotonin or catecholamine-containing neurons. Lesions of the midbrain raphe, which cause a marked decrease of serotonin in the forebrain, were without any effect on the estrus cycle, fertility and activity of the steroids under study. An intraventricular injection of 6-hydroxydopamine, which causes a selective decrease of noradrenaline and dopamine in the forebrain, produced a transient effect only on the estrus cycle but did not significantly change the fertility or the activity of the substances investigated. The data indicate that the integrity of monoaminergic neurons in the brain is not an essential condition for the aspects investigated in the present study.