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Progestin only birth control pills appeared on the US market in 1973. As there is no estrogen in these mini pills, they may have fewer dangerous side effects than the combined pills. Some clinics suggest mini pills for women who suffer from estrogen excess side effects. The 3 mini pills available in the U.S. are called Micronor, NOR-QD, and Ovrette. Instructions are presented for patients who are interested in using mini pills. The mini pills most likely work by affecting a women's fertility in several ways: act as a messenger to the woman's ovaries and uterus to prevent the release of an egg; thicken the mucous on the cervix, making it difficult for the sperm to "get through" the cervix and reach the egg; and change the lining of the uterus so that it may not develop properly for the fertilized egg to grow. The mini pills can be 97% effective is used perfectly. The mini pills are only effective for as long as a woman takes them. A woman must take a pill every day to prevent pregnancy. A woman should not use the mini pill if she has or ever has had any of these problems: blood clotting problems in veins; stroke; cancer of the breast or reproductive parts of the body; suspected pregnancy, current pregnancy; and undiagnosed, abnormal genital bleeding. Possible benefits for a woman using mini pills include: an effective method of birth control; a method for nursing mothers since it does not seem to affect the amount of their breast milk; and a possible reduction in premenstrual cramps. Possible risks for a woman using mini pills include: irregular periods; and a less effective method if the patient does not take a pill every day. The danger signals to look for are abdominal pain, chest pain, headaches, eye problems, and severe leg pain. A patient should revisit a clinic in the following situations: has not had a period within 45 days of the last period; severe abdominal pains while taking mini pills; experiences a warning signal; any time one thinks the pills are causing trouble; and once a year for a pap smear, breast examination, and laboratory tests.
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PMID:How to use mini-pills: helpful patient instructions. 1226 79

Fertility control by cyclic norethindrone (Norlutin), 17 alpha-ethinyl 19-nortestosterone, plus .06 mg 3-methoxy ethinyl estradiol (Ortho-Novum) was studied in 364 women over a period of 32 months for a total of 6062 cycles. No patient who followed the instructions became pregnant. 37 patients stopped the medication for various reasons. The interval between stopping medication and becoming pregnant averaged 1.6 months. 13 of these pregnancies occurred after 11-15 cycles of treatment. Children born to these mothers were normal with no virilization observed. Findings from all Papanicolaou smears and cervical biopsies were normal. The desirable effects of diminishing the menstrual flow, reducing dysmenorrhea and regulating the menstrual cycle, plus the all-important one of contraception, far outweighed minimal and infrequent undesirable side effects (in order of frequence: chloasma, hot flashes, headache, nausea, acne, abdominal pain, dizziness and urticaria). In only 4.8% of the total 6062 cycles was some complaint made.
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PMID:Long-term administration of norethindrone in fertility control. 1227 4

A recent case-control study by a team of University of Southern California investigators follows published observations on a total of 107 liver tumors among young women. Most of them were, or had been, oral contraceptive users. The importance of duration of use in the etiology of these tumors was shown by data on 58 women reported at the 1976 annual meeting of the American College of Obstetricians and Gynecologists. Of the 58 women who developed these tumors, 85% had used the pill continuously for more than 4 years. An increasing number of such reports has induced the National Cancer Institute to undertake an investigation regarding these tumors. Almost all of the reported tumors have been benign and described as adenomas, hamartomas, or focal nodular hyperplasia. Some have been without symptoms. Others have been associated with severe abdominal pain or sudden bleeding. A case-control study of 34 young women diagnosed as having benign liver tumors in 1955-1976 was made with appropriate controls. Of the 34 tumor cases, 29 had used oral contraceptives but 26 of the controls had done so also. The tumor patients had taken the pills for significantly longer periods than the controls. The risk of developing liver tumors increased with duration of use and was 2.5 times greater than after 3-5 years than for 1 year or less of use. After 5 years of use, the risk increased sharply to 25 times greater after 9 or more years of pill use. A palpable mass was present in 34% of the cases and severe abdominal pain in 29% of 1 series. Pills containing mestranol seemed more likely to cause liver tumors than those containing ethinyl estradiol. Another report was of 44 case histories published within the past 5 years and 27 new cases reported to the Registry for Liver Tumors Associated with Oral Contraceptives. This Registry was established in 1975. Duration and type of pill use was recorded for 58 of them. Of these, 85% had taken the pill for over 4 years. Mestranol-containing pills had been mostly used. Norethindrone was often used. Of these tumors, 18 ruptured resulting in the death of 8 of the 71 women. In Louisville, 9 cases of benign liver tumors were diagnosed between 1968 and 1974 in women who had used oral contraceptives. No similar tumors had been observed in a comparable age group of women in the previous 13 years. In 1 case, a patient had the tumor removed and resumed the pills. After 6 years a 2nd similar tumor developed. It was not removed but regressed somewhat in 5 months when the oral contraceptive was omitted. In Britain and the U.S., 3 prospective studies of pill users are being conducted. The different types of liver tumors involved seem to have different etiologies. Focal nodular hyperplasia is sometimes found in men but liver-cell adenoma is almost exlusively found in women, many of whom have used oral contraceptives. The Central Registry may resolve some questions.
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PMID:Case control study finds long-term pill use is associated with higher risk of benign liver tumors. 1233 49