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During the past decade the World Health Organization (WHO) has embarked on a $17 million program to study different kinds of contraceptive methods and their effect on maternal health. More than 600 scientists from 85 countries are participating. These investigations have implicated abortion as a factor in miscarriage, perinatal morbidity, and perinatal mortality due to isthmus-cervical inadequacy. It is also implicated in sterility and extrauterine pregnancy, as well as other disorders of pregnancy. Hence WHO emphasizes other birth control methods, in particular the pill. But the birth control pill also has side effects, as this is the first time that hormones have been used not to treat some illness but in healthy women. Their incidence increases with age (after 30-35 years of age) and also is enhanced by smoking, high blood pressure, hyperlipoproteinemia, and diabetes. Oral contraceptives (OCs) also reduce the incidence of benign tumors of the breast, ovarian cysts, iron-deficiency anemia, and rheumatoid arthritis. They have a beneficial effect also in endometriosis, dysfunctional hemorrhages, polyposis and endometrial hyperplasia, ovulatory problems, and inflammatory conditions of the genitals. Many of the longterm effects of these contraceptives are still unknown, such as their influence on cancer or on the fetus. The WHO investigation has shown that 1/2 stop taking the birth control pill after 1 year, and 2/3 after 2 years. Another widespread technique is the IUD, used by over 60 million women. But this causes hemorrhage in some, especially the women of India, Pakistan, and other countries. Work is now being done on ways to minimize the hemorrhage associated with the IUD, to clarify its presence as a cause of inflammatory processes of the genitals, extrauterine pregnancies, and subsequent sterility. The WHO also studied the rhythm method of preventing conception and found that 35% of women ceased employing it after 13 months, while 20% became pregnant. It was decided to work on elucidating new methods of determining the onset of ovulation. The WHO is also studying the use of prostaglandins to interrupt pregnancy. A major task for the future is determining which women are at greatest risk from the various birth control techniques.
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PMID:[Modern methods of regulating generative function]. 733 55

Recent cohort and case control studies of low-dose combined oral contraceptives (COCs) containing the new generation of progestogens have allowed classification of adverse effects into those which are rare but serious and should be considered risks and those which are more frequent but are less of a threat to health. Low-dose COCs continue to affect coagulation in a complex way, but the risk is less than with the older preparations, and it can be minimized by screening women for a personal or familial history of early or unusual thrombosis and for levels of protein C, S, and antithrombin III. Women with true migraine with focal signs should also avoid using COCs. The relative risk of myocardial infarction (MI) may increase from 4:1 in women with one risk factor (age, smoking, hypertension, hyperlipidemia, and diabetes) to 20:1 with two risk factors and 128:1 with three or more risk factors. In the absence of all risk factors, a recent study indicated that the relative risk of MI with COC use was 1.9 for current and past use. COC use also causes a slight increase in hypertension in most women, especially those who are older or have a family history of hypertension. While the COC can affect carbohydrate and lipid metabolism, the new generation of progestogens has reduced these effects. The COC may accelerate presentation of gallbladder disease in predisposed women. The COC protects against benign breast disease but may increase the risk of breast cancer and cervical cancer slightly. There is a strong link between hepatocellular adenoma and COC use, but the incidence is low. Return to fertility after use has not been a problem. Both estrogenic adverse effects (nausea, dizziness, irritability, weight gain, bloating) and progestogenic adverse effects (vaginal dryness, acne, hirsutism, weight gain, depression, loss of libido) can occur in 50% of women, but these generally disappear after a few months of use. In conclusion, the low-dose, third generation COCs are associated with minimal risks in the absence of other risk factors and have many beneficial effects such as the prevention of ovarian and endometrial cancer; a decrease in pelvic inflammatory disease and ectopic pregnancies; and protection from anemia, primary dysmenorrhea, functional ovarian cysts, and benign breast disease as well as from the morbidity and mortality associated with pregnancy.
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PMID:The combined oral contraceptive. Risks and adverse effects in perspective. 776 40

Oral contraceptives (OCs) were first introduced more than 30 years ago. OC manufacturers have reduced the dosage of synthetic estrogens (e.g., ethinyl estradiol, 100-150 mcg to 20-35 mcg) and progestins to limit their metabolic effects on lipoproteins, carbohydrates, and hemostasis. In addition to protection from pregnancy, OC benefits include lower incidence of painful periods, excessive bleeding, and iron deficiency anemia; reduction of ovarian cysts, benign breast tumors, and pelvic inflammatory disease; and protection against endometrial and ovarian cancers. The risk of a cardiovascular event (myocardial infarction, cerebrovascular events, venous thromboembolism, and deep vein thrombophlebitis) in OC users is 1-2/100,000 women years. Cardiovascular risk factors include smoking, hypertension, lipid disorders, severe obesity, diabetes mellitus, and cardiovascular events in first degree relatives before age 40. Thus, women with any of these risk factors should not use OCs. OCs do not increase the risk of breast cancer in women less than 59 years old. They may increase this risk if used over a long duration before the first fullterm pregnancy. OCs may cause a modest increase in cervical neoplasia. Low-dose OCs have a small effect on lipid metabolism. OCs increase serum triglycerides 30-50%. OCs increase insulin secretion and hyperinsulinemia increases the cardiovascular risk. Practitioners should evaluate clients before prescribing OCs. They should not prescribe OCs to women with hypertension, diabetes mellitus, lipid disorders, gynecological cancers, and previous cardiovascular disorders. Practitioners should tell clients that smoking is a leading risk factor and about OC's side effects (e.g., menstrual disturbances). The physical exam should include a cervical PAP smear, gynecological exam of the uterus and the ovaries, and a breast exam. Practitioners should test cholesterol and triglycerides before and during OC use. Premenopausal healthy women with no risk factors can use low-dose OCs.
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PMID:Update on oral contraception. 836 2

The diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was established in persons (6 adult and 8 children) among 34 members of a three generations family. The presence of coexisting cysts in liver was ascertained in 3 women, and the presence of ovarian cysts was discovered in a 14 years old girl. Arterial hypertension was observed in 2 men and 2 women. The symptoms of initiating renal failure were found in 1 patient. The clinical observation of the most numerous among described in accessible literature family will be continued.
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PMID:[Autosomal dominant polycystic kidney disease in a large family]. 875 83

Although an individual assessment of the risks and benefits is always essential, combined, low-dose oral contraceptives (OCs) are an effective method of fertility control, even for women with chronic medical problems. In addition to contraception, therapeutic uses of combined OCs include acne, anovulatory uterine bleeding, control of bleeding with blood dyscrasias, dysmenorrhea, endometriosis, hirsutism, hypothalamic amenorrhea, ovarian hormone replacement, polycystic ovarian syndrome, premenstrual syndrome, and recurrent functional ovarian cysts. This article presents guidelines for clinicians on the selection of combined OC users, counseling, contraindications, and management of adverse effects. It further outlines general considerations for the prescription of combined OCs to women with hypertension, diabetes mellitus, migraine headaches, and epilepsy.
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PMID:Combination oral contraceptives. 917 54

To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed data from a case-control study. Cases were 971 women below the age of 75 years with histologically confirmed epithelial ovarian cancer, admitted to a network of hospitals including the major teaching and general hospitals in the greater Milan area. Controls were 2758 women admitted to the same network of hospitals for acute, non-gynaecological, non-hormone related, non-neoplastic conditions. Obesity/severe overweight were inversely associated with the risk of ovarian cancer (multivariate relative risk, RR, 0.66, 95% confidence interval, CI, 0.52-0.85). Hyperlipidaemia was also inversely related to ovarian cancer risk, (RR 0.64, 95% CI 0.45-0.89). No relationship emerged between ovarian cancer risk and diabetes (RR 0.80, 95% CI 0.54-1.19), hypertension (RR 0.85, 95% CI 0.68-1.06), thyroid diseases (RR 0.89, 95% CI 0.63-1.13) and cholelithiasis (RR 0.86, 95% CI 0.66-1.12). A decreased frequency of ovarian cancer was seen in women with a history of uterine leiomyomas (RR 0.66, 95% CI 0.47-0.92) and benign ovarian cysts (RR 0.69, 95% CI 0.41-1.13).
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PMID:Ovarian cancer risk and history of selected medical conditions linked with female hormones. 938 10

A decrease in urinary volume during surgery is often encountered. Usually it can be treated with intravenous fluid or diuretics. We here report a rare case of intraoperative anuria in which renal blood flow ceased totally. The patient was 36 year old female (166 cm 50 kg), who was admitted for a investigations of long-term severe hypertension of unknown origin. Radiographic examination showed no adrenal tumor but a right ovarian cyst was found and suspected to be malignant, for which oophorectomy was indicated. After epidural catheterization, general anesthesia was induced by intravenous propofol and vecuronium, and maintained with epidural lidocaine and the inhalation of isoflurane and nitrous oxide mixed with oxygen. During surgery, urinary outflow decreased gradually leading to total anuria, which was resistant to intravenous fluid and furosemide. Intraoperative pyelography was performed and both kidneys and urinary tracts were not visualized. After the surgery, when the patient returned to the ward, urine began to flow. Postoperative pathological examination of the removed ovary showed a presence of renin excreting tumor cells. The anuria was considered to be the result of transient spastic obstruction of bilateral renal arteries, presumably in response to a high level of plasma renin.
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PMID:[Anuria due to bilateral renal artery spasm during hysterectomy and oophorectomy]. 1051 79

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73

Earlier and more frequent sexual activity and the significant risk of pregnancy have increased the need for contraception among young adolescent girls. The problem for the physician is to choose a contraceptive method which will not affect future fertility or the psychological and biological maturity of adolescents. Condoms, diaphragms, and spermicides are quite effective if used correctly; they have no deleterious side effects, and they provide protection against sexually transmitted diseases. They appear to be well-adapted to the sporadic sexual activity of adolescents. The efficacy of combined oral contraceptives (OCs) is also high. Side effects depend on the synthetic estrogen component and are dose dependent. Absolute contraindications to OC use in women of any age include thromboembolic disease, cerebral vascular accidents, severe cardiac or hepatic disorders, breast or genital cancer, pregnancy, undiagnosed genital bleeding, and pituitary adenoma. Relative contraindications include hypertension, diabetes, hyperlipidemia, obesity, history of hepatitis, migraines, epilepsy, asthma, renal insufficiency, cystic breast disease, and mammary fibroadenomas. Combined OCs do not seem to interfere with subsequent maturation of the hypothalamopituitary axis. The frequency of ovulatory cycles in adolescents who have discontinued pill use is the same as that in adolescents who have never used pills. However, estrogens accelerate the process of maturation in the bones, so combined OCs should never be prescribed for girls who have not terminated their growth. Minidose OCs containing 30-45 mcg of ethinyl estradiol aggravate the relative hyperestrogenism of adolescents and are associated with menstrual problems, functional ovarian cysts, and breast problems. They should only be prescribed for adolescents with regular sexual activity, no less than 3 years following menarche, with regular ovulatory menstrual cycles and no history of breast disorders. Otherwise, a standard-dose combined pill with 50 mcg EE should be selected. Continuous dose progestin minipills depend on peripheral effects such as modifications in the cervical mucus for their contraceptive effects. They are associated with frequent menstrual problems, functional ovarian cysts, and extrauterine pregnancies. They may be indicated for adolescents with regular sexual activity but with contraindications to combined OCs. Trimonthly injections of medroxyprogesterone acetate have major effects on endocrine metabolism and should be used only for adolescents with severe mental problems. IUD efficacy is high but they may be less well tolerated by adolescents than by older women and the risk of infection may be heightened. They should only be used for adolescents with absolute contraindications to use of hormonal contraceptives who have no history of genital infections.
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PMID:[Choosing contraception for adolescents]. 1228 May 85

The Indian government's plan to introduce the new long-acting contraceptive Norplant in the National Family Planning Program under pressure from the US government is opposed because Norplant has not been adequately tested. The government has reduced the funding for the national program for eradication of malaria and tuberculosis, but it is proposing to finance a Norplant based population project for the State of Uttar Pradesh. The powers that can turn a deaf ear to the possible hazards of Norplant. Implanted in the arm of a woman, the chemical is released into the bloodstream providing contraception for 5 years. Severe adverse reactions include depression, heart disease thromboembolism, high blood pressure, and ovarian cysts. Many such long-acting contraceptives are being developed including injectables, vaccines, nasal sprays, and vaginal rings with potential permanent impairment to fertility. One of the major objectives of the Family Planning Program is the improvement of the health status of women, but the introduction of Norplant would harm healthy young women. Therefore, the group Saheli and others in the campaign demand: 1) that plans for introduction of Norplant in the Family Planning Program be halted immediately; 2) that the introduction of any other long acting invasive contraceptive such as Net-En, vaginal ring, nasal spray, and anti-fertility vaccine be banned, both on the grounds of inadequacy of the health services and loss of user controls; 3) that information on the safety aspects of Norplant and the basis on which the Drugs Controller has granted his approval be made public; 4) that each and every one of the hundreds of women who still have the implant should be located, and the implant removed; and 5) that all hormonal contraceptive preparations be banned in the social marketing program as their use involves extensive monitoring.
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PMID:Norplant campaign in India. 1228 26


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