Pituitary-adrenal function in oral contraception

14 normally menstruating women aged 17 to 29 were treated cyclically with a daily dose of 5 mg of 6-methyl-6-dehydro-17α-acetoxyprogesterone (megestrol acetate) + 0.1 mg of 17α-ethynyl-oestradiol-3-methylether (mestranol) for a period of 3 to 74 weeks. During treatment we found a gradual decrease in the excretion of both 17-ketogenic steroids (17-KGS) and 17-ketosteroids (17-KS). After cessation of treatment, we found a rapid increase to pre-treatment levels in the excretion of both 17-KGS and 17-KS.

The decrease in the output of 17-KGS and 17-KS observed during treatment with megestrol acetate + mestranol might be explained by:

The purpose of the present investigation was to explore these hypotheses. 8 patients were treated with the above mentioned dose of megestrol acetate + mestranol until the excretion of pituitary gonadotrophins was significantly suppressed. This occurred after a treatment-period of 3 to 10 months. In all 8 patients we determined the responsive to metyrapone before the treatment started and a short time before the treatment was discontinued. During treatment all 8 patients showed a normal response to oral administration of metyrapone. Furthermore, in 6 out of the 8 patients we tested the response of the adrenal cortex to intravenous and intramuscular administration of corticotrophin (ACTH) just before the treatment was discontinued. In all patients a normal ACTH-stimulation test was found. During treatment, the concentration of plasma cortisol was significantly increased to values about 3 times the control values, whereas the concentration of plasma 11-deoxycortisol (compound S) remained unchanged. This high plasma cortisol level during treatment is probably caused by an increased protein-binding of cortisol.

As both the responsive to metyrapone and to ACTH is normal during treatment with megestrol acetate + mestranol, we are of the opinion that the decrease observed in the excretion of 17-KGS and 17-KS is due to a change in the metabolism of the corticosteroids.

Postponement of menses, suppression of urinary gonadotrophins, 17-KGS and 17-KS in normal women treated with a megestrol acetate/mestranol combination (delpregnin) from day 20 of the cycle

Ten normally menstruating women, ranging in age from 19—32, received 5 mg of megestrol acetate plus 0.1 mg of mestranol from day 20 of the cycle daily for 20 days.

Individual 48 h urine collections were obtained from cycle days 7—8, 13—14, 18—19, and from days 9—10 and 19—20 during the treatment. Each 48 h specimen was assayed for »total« gonadotrophins, 17-KGS and fractionated 17-KS. The basal temperature and occurrence of menstruation were noted before, during and after the treatment.

In 7 cases unequivocal suppression of gonadotrophins was observed during the medication period, and all these women had their expected menstruation postponed until after termination of the treatment. The next menstrual cycles were ovulatory and regular in relation to the postponed menstruation. In 3 cases no suppression of gonadotrophins was observed and these same cases had no postponement of menstruation.

The mean excretion of 17-ketogenic steroids and of 17-ketosteroids (total 17-KS, dehydroepiandrosterone, androsterone and aetiocholanolone fractions) in the whole group was significantly depressed at the end of the treatment period.

Acute phase protein in serum of women using hormonal contraceptives

Acute phase protein precipitating sonatic C-polysaccharide of pneumococci appears in serum of women under treatment with hormonal contraceptives in a significantly higher number of cases when compared with control groups. The summarized results of three preliminary studies show that in 80 control serums there were four positive specimens (5 percent) and in 80 serums from women using hormonal contraceptives there were 58 positive specimens (72.5 percent).

Effects of some steroids in oral contraceptives on the cleavage of rabbit eggs in vitro

The effects of the oestrogens and progestins in some common oral contraceptives on the cleavage of fertilized rabbit ova were studied in vitro. Three concentrations (5, 10 and 25 μg./ml.) of each of four progestins (norethynodrel, norethindrone, norethindrone acetate and 17α-hydroxy-6α-methylprogesterone acetate) and of two oestrogens (mestranol and ethinyloestradiol) were tested. All but norethindrone and norethynodrel had some effects on the cleavage of ova. Three effects were seen: complete inhibition of cleavage, slowing or retardation of cleavage, and fragmentation (division of the egg into numerous spherical or ovular bodies).

Differences between conditions in vivo and in vitro and the mechanism of these actions of the steroids are discussed.

Augmentation by chlormadinone of the uterine weight response to human chorionic gonadotrophin in intact immature rats

Administration of chlormadinone, an orally active progestational agent without significant oestrogenic activity, to intact immature female rats did not affect either ovarian or uterine weight significantly compared with controls. A single injection of human chorionic gonadotrophin (HCG) caused a 73 % increase in uterine weight in 24 hr. over the control value. This dose significantly increased ovarian weight and although it caused some stimulation of follicular development, ovulation during this time did not occur.

When animals were treated with chlormadinone for 8 days, and received HCG on the 8th day, uterine weight was 170% greater than in the controls and 56% greater than with HCG alone. The uterine weight produced was similar to that found in animals treated with mestranol, a potent oestrogen, and HCG. In ovariectomized animals HCG did not affect uterine weight, while the small increase produced by chlormadinone was unaltered when HCG also was given.

Mechanisms are discussed by which this augmentation of the uterine response to HCG might be produced. It seems most likely that chlormadinone administration causes storage of endogenous gonadotrophin in the pituitary, and that the exogenous gonadotrophin acts as the 'trigger' for the release of stored hormone, probably by a direct action on the hypothalamus.