[Study of the mechanism of postcoital contraception in the combination of streoids and the central m-cholinolytic, amizil]

Experiments on female rats showed the blocking of the M-cholinoreactive system with amizyl to significantly contribute to the estrogen/norsteroid contraceptive effect during the postcoital periods. This effect was accompanied by decrease in the gonadotropin level and by the change in the LH/FSH ratio, this creating an unfavourable background for implantation of the fertilized ovicell in the endometrium. There was a change in the transport rate in the tube and a delay in the decidual reaction. Changes in the rate of the ovicell transport were not accompanied by distrubances in the process of fertilization or with the cytotoxic action. Mestranol and ethynylestradiol in combination with norethynodrel (1:20) and with the central cholinolytic amizyl were agents with future prospects for short-term postcoital contraception.

[Insulin and proinsulin secretion under contraceptive steroid administration (author's transl)]

An ivestigation has been performed in 49 women about the influence exerted on the glucose-tolerance, insulin and proinsulin secretion by hormonal contraceptives of different types and compositions. A disturbed dynamics of the insulin secretion with elevated values in the OGTT at two and three hours has been proven at a nearly equal degree using combined preparations (Anacyclin, Eugynon, Neogynon, Mikrogynon) or sequential preparations (Kombiquens, Ovanon). Though there has been interference with the glucose tolerance, the serum proinsulin in the OGTT showed increased levels too. When a combined preparation was applied, the proinsulin values were significantyl higher compared to a sequential type contraceptive. The observed disturbance of the insulin and proinsulin secretion is explained by a decreased sensitivity to insulin in the peripheral fat tissue. The actual dose of the estrogen-gestagen components has no influence on the described changes. Elevated insulin levels are demonstrable already during the first treatment cycle. The degree of the disturbance is independent of the duration of the medicamentous application during the first 6 contraceptive months. After withdrawal of the respective contraceptive steroid the insulin secretion showed nearly normal dynamics during the subseqeunt menstrual cycle.

Ocular effects of oral contraceptives. I. Studies in the dog

The administration of two oral contraceptives to female dogs for 5 years did not produce ocular lesions. Corneal and lenticular opacities occurred with equal frequency in control and treated groups, and fundic lesions, including papilledema, venous dilatation, and venous or arterial retinal thrombosis, were not produced by doses of Enovid-E or Ovulen 1, 10, and 25 times the human dose.

Ocular effects of oral contraceptives. II. Studies in the rhesus monkey

Oral contraceptives were administered cyclically to 96 female rhesus monkeys for 5 years. Forty-eight animals received Enovid-E and 48 were treated with Ovulen at doses 1, 10, and 50 times the human dose. Ophthalmic lesions did not occur at any of the dose levels employed. Significant fundic lesions, including papilledema, venous dilatation, venous retinal thrombosis, or arterial retinal thrombosis, did not develop in any of the treated animals.

Effect of contraceptive steroids on arginine-stimulated glucagon and insulin secretion in women: I-Lipid physiology

To evaluate the effect of contraceptive steroids on endogenous glucagon and insulin secretion, theta-arginine was infused intravenously in normal young women before and during selective steroid treatment. The effect of the combination of an estrogen derivative (mestranol), plus norethindrone (Norinyl, Syntex) was compared to the effect of ethinyl estradiol alone and to norethindrone alone. All three steroid schedules resulted in suppression of aminogenic insulin secretion. However, glucagon secretion was reduced only with ethinyl estradiol alone or the combination of mestranol plus norethindrone. In accordance with previous reports, treatment with an ethinyl estradiol derivative alone or in combination with norethindrone resulted in a tendency for elevated serum lipid concentration, while norethindrone alone resulted in a significant reduction in serum lipid concentration. These observations suggest an inverse relationship between aminogenic glucagon secretion and serum lipid concentration as influenced by contraceptive steroids. It is suggested that the metabolic effects of these steroids may be mediated in part by the associated alterations in pancreatic hormone secretory capacity.

Effect of 17alpha-ethinylestradiol on biliary excretion of bile acids

The effect of 17alpha-ethinylestradiol on biliary bile acids has been investigated. The ratio of cholate to chenodeoxycholate was diminished by the estrogen in cholestyramine-treated rats. With low doses, this effect was due to increased excretion of chenodeoxycholate. With the highest dose, the decreased ratio was due to a reduction in the levels of cholic acid. In the intermediate dosage range, both factors contributed to the decreased ratio. Prolonged treatment with 500 mug daily of 17alpha-ethinylestradiol produced a reduction in the excretory rate of both bile acids in animals treated or not treated with cholestyramine.

Bone mineral: effects of oral contraceptives, pregnancy, and lactation

Estimating bone mineral by the photon absorption (125I) method applied to the distal part of the radius, it was found that young women using oral contraceptives containing a daily dose of 100 micrograms of mestranol had higher concentrations of bone mineral than non-users. Women twenty to fifty-nine years old who had lactated were among the poorly mineralized, while those who had lactated but were now using oral contraceptives in various combinations were among the highly mineralized.

Comparative studies of the ethynyl estrogens used in oral contraceptives. III. Effect on plasma gonadotropins

Twenty-one-day treatment cycles of ethynylestradiol or mestranol at dosages of 50 to 100 mug per day were administered to 191 normal volunteer women from six cycles, followed by six cycles of this estrogen treatment combined with 2.5 mg. of norethindrone acetate, 2 mg. of megestrol acetate, or 0.5 mg. of norgestrel. The drugs were prepared to insure uniform bioavailabiltiy. Plasma FSH and LH were determined by radioimmunoasay during the last week of medication intake in each cycle. In another study, a large number of blood samples were obtained at various times during the menstrual cycle from women using IUD's (as a control population) and from women who had been taking oral contraceptives regularly for 5 to 12 years. With the various estrogen treatments, the median FSH level showed no change at any estrogen dose at the end of the first cycle. From the second cycle on, a stable, dose-related fall was obtained with the 80 or 100 mug per day doses. The addition of any of the three progestins caused a prompt, stable, further fall in FSH level. By contrast, the median LH level rose in the first cycle with all estrogen regimens, and then fell progressively in a dose-related fashion in cycles 2 to 6. The addition of a progestational agent also caused a further prompt and stable fall in LH during cycles 7 to 12. Except for a minimal indication of greater LH suppression by ethynylestradiol as compared to mestranol at 50 mug per day, all other indices and dosages showed ethynylestradiol and mestranol to be essentially equipoten under these experimental conditions. Long-term administration of oral contraceptives produced a comparable degree of gonadotropin suppression. There was a suggestion of slightly less FSH suppression with agents using 50 to 75 mug per day of estrogen than from those with 100 mug per day. Both in normal controls (IUD cycles) and in cycles under chronic treatment with oral contraceptives, pulses of both FSH and LH were seen with some frequency, at times distant from the "periovulatory" period. The significance and origin of these random FSH and LH pulses is unknown.

Comparative studies of the ethynyl estrogens used in oral contraceptives. I. Endometrial response

Reproductive-age women were given identically prepared mestranol or ethynylestradiol orally for two consecutive 21 day cycles in doses ranging from 50 to 100 mug per day. Endometrial biopsies were obtained at the end of the second cycle and assessed for estrogenic effect. At these dose levels and with this treatment regimen, no differences could be detected between doses or between drugs, indicating that a plateau in endometrial response was reached.

Serum tsh and serum t3 levels during normal menstrual cycles and during cycles on oral contraceptives

Serum TSH and serum T3 levels were studied in 35 normally menstruating women and in 35 women on oral contraceptives in order to find out whether the levels of TSH and T3 were related to the menstrual cycle or changed by oral contraceptives. Serum TSH AND T3 were found to be unchanged throughout the normal menstrual cycles and during the cycles of oral contraceptives. The TSH level was higher in the women on oral contraceptives than in the normally menstruating women. This might be due to a direct thyroid inhibitory effect of oestrogen. As could be expected the levels of T3 and T4 were higher in women on oral contraceptives than in normally menstruating women.

Comparative studies of the ethynyl estrogens used in oral contraceptives. II. Antiovulatory potency

The occurrence or inhibition or ovulation was inferred from the plasma progestin level measured in the last week of 430 control cycles and of 4,638 cycles from fertile women receiving various antiovulatory steroids, singly and in combination. The substances tested included: mestranol and ethynylestradiol (EE) of homogeneous bioavailability, used alone in a range from 50 to 100 mug per day; these same dose levels combined with various progestins; and finally various proprietary combination and sequential low-dose regimens undergoing clincial trials. Statistical analysis showed ethynylestradiol and mestranol alone to be equipotent over the tested range, although at 50 mug per day superiority of mestranol over EE was suggested. Two preparations of EE at 50 mug per day, one of them a sequential with dimethisterone, showed different potency. At 50 mug per day no estrogen, alone or with a sequential progestin, reached a satisfactory level of effectiveness. However, very small amount in the range of 20 to 40 mug per day were highly effective when combined with quantities of various 19-nor progestins which by themselves are well below the antiovulatory level. This indicated that a synergism exists between these two classes of compounds insofar as their antiovulatory effect is concerned, thus explaining the high contraceptive effectiveness observed with very-low-dose combination regimens.

Mutual modification of glucose-stimulated serum insulin responses in female rhesus monkeys by ethinyl estradiol and nortestosterone derivatives

Changes in iv glucose tolerance (IVGTT) and serum insulin responses to glucose infusion have been measured in intact female rhesus monkeys treated per os with norethindrone or medroxyprogesterone acetate (500 mug/day) both alone and in combination with mestranol or ethinyl estradiol (10 mug/day) orally for 3 weeks. When administered as the sole contraceptive steroid, neither norethindrone, medroxyprogesterone acetate, mestranol, or ethinyl estradiol produced consistent changes in fasting serum insulin or glucose concentration, mean intravenous serum glucose disappearance rates (K) or mean integrated serum insulin response to glucose (sigmal40). By contrast, concurrent administration of norethindrone with mestranol or ethinyl estradiol resulted in a significant increase in the fasting serum insulin concentration and the mean sigmal40. An increase in the mean K was also observed after norethindrone + mestranol. These results show that synthetic estrogens have the ability to potentiate the metabolic effects of norethindrone. However, the improvement in glucose tolerance produced in rhesus monkeys by concurrent mestranol + norethindrone treatment was marginal because of wide variation in glucose assimilation rates uncer control conditions. Thus, the IVGTT in the rhesus monkey appears to have limited use as a model for studying glucose homeostasis in man.

Effects of a progestogen and a sequential type oral contraceptive on plasma vitamin A, vitamin E, cholesterol and triglycerides

Fasting blood samples were taken from 13 college students who had never been on oral contraceptives in two menstrual cycles. During the first cycle, the control cycle, each girl donated three blood samples; the first sample was given between days 1 and 5, the second sample between days 13 and 17, and the third sample between days 22 and 26 of the menstrual cycle. In the second menstrual cycle, the experimental cycle, nine girls were given Micronor, a progestogen type oral contraceptive and four girls were given Ortho-Novum SQ, a sequential type oral contraceptive. Four blood samples were obtained from each of the subjects: the first three samples were obtained in the three periods corresponding to those in the control cycle, and the fourth was taken 2 days after the subjects had stopped taking the oral contraceptive. Results showed that estrogen significantly raised plasma vitamin A and triglycerides. The progestogen, at low concentration, had little or no effect on these two lipid materials. At a higher concentration the progestogen enhanced the effect of the estrogen on plasma vitamin A and triglycerides. These effects were extended to at least 2 days after subjects had ceased taking the oral contraceptive. Plasma vitamin E levels in the subjects given Ortho-Novum SQ, were consistently but not statistically higher in the experimental cycle than in the control cycle. The correlation coefficient between vitamin E and triglycerides was statistically significant while those between the vitamin A and vitamin E and between vitamin A and triglycerides were not. Cholesterol was not affected by either Micronor or Ortho-Novum SQ.

Adrenal function in hirsutism I. Diurnal change and response of plasma androstenedione, testosterone, 17-hydroxyprogesterone, cortisol, LH and FSH to dexamethasone and 1/2 unit of ACTH

ACTH dependency of plasma androstenedione (A) and testosterone (T) was determined in normal and hirsute women by measuring the magnitude of change of A and T between the time of the cortisol (F) peak and F nadir in a diurnal study. There was a significant diurnal rhythm of A synchronous with F in both normal and hirsute women (P less than 0.01). Five of 12 hirsute women had a greater than normal diurnal swing of A (P less than 0.05), but only 2 of the 12 had a greater than normal diurnal swing of T. Responsiveness of A and T to 1/2 unit of intravenous ACTH was determined after dexamethasone 1 mg was given the night before. Plasma A and T were elevated in most of the hirsute women during acute ACTH suppression by dexamethasone, indicating ACTH-independent hypersecretion of androgens. Nine of 17 hirsute women had a greater than normal A response to ACTH (P less than 0.05). Those who had an exaggerated diurnal swing of A also had hyper-responsiveness of A secretion to ACTH. Only 2 hirsute women had an exaggerated T response to ACTH. Some T levels were decreased by ACTH. Seven of the 9 hiruste women who had an exaggerated A response to ACTH had a normal maximum F response, but a greater than normal 17-hydroxy-progesterone (17-OHP) response to ACTH with a high 17-OHP to F ratio, suggesting they have a mild but compensated reduction in 21-hydroxylase or 11beta-hydroxylase activity. Two women with hyper-responsiveness of A secretion had low F and 17-OHP responses to ACTH suggesting reduced C21 but intact C19 3beta-hydroxysteroid dehydrogenase-delta-5,-4 isomerase activity. These apparent reduced enzyme activity may not be congenital, but induced by an altered hormonal milieu such as an abnormal androgen-estrogen ratio. It is concluded that ACTH uniformly stimulated A secretion but not T secretion and that approximately 50% of the hirsute women had ACTH-dependent hypersecretion of A, but most of these also had concurrent ACTH-independent hypersecretion of androgens.

Oral contraceptives: effects on plasma insulin response to glucose and on the response to insulin and 2-deoxyglucose uptake by peripheral tissue

Oral contraceptive steroids, norethynodrel and mestranol, were fed to 11-wk-old female Sprague-Dawley rats, in combination and in quantities proportional to those used by women for contraceptive purposes. Three experiments were performed. The first experiment, demonstrated that 10 wk of treatment, impaired the animal's glucose tolerance, but not its insulin response to glucose. The second experiment demonstrated that 6 wk of steroid feeding, decreased the in vivo conversion of blood U-14C-labeled glucose into adipose tissue fatty acids and into diaphragm glycogen, although the effect on the diaphragm was not statistically significant. In the third experiment, it was found that the uptake of 2-deoxyglucose-1-14C by the adipose tissue removed from rats after 6 wk of treatment, was not different from that of control tissue, but the uptake by the hemidiaphragms was slightly lower.

Radioimmunoassay of unconjugated plasma ethynylestradiol in women given a single oral dose of ethynylestradiol or mestranol

A method for the radioimmunoassay of ethynylestradiol in plasma is described. The sensitivity is 18 pg/ml, recovery 86.5%, and precision 10.9% (coefficient of variation). Normal women, five at each dose level, were given 50 or 80 mug ethynylestradiol or 50, 80, or 100 mug mestranol of uniform bioavailability. Peak plasma levels were consistently obtained in the 1-hour plasma sample with the former compound. With mestranol, the peak levels of ethynylestradiol were lower than with the same quantity of ethynylestradiol and the time-curve of plasma levels much more variable. With this procedure, it is now possible to study certain aspects of the pharmacokinetics of these clinically important compounds.

Oral contraceptives and ascorbic acid

Plasma, leukocyte, and platelet ascorbic acid levels are decreased in women ingesting oral contraceptive steroids. Studies have shown that it is the estrogenic component of the oral contraceptive agents that is associated with the decresased ascorbic acid concentrations. Urinary excretion of ascorbic acid does not appear to be increased by the steroids. Although serum levels of copper are increased by estrogens and oral contraceptives, ascorbic acid catabolism does not appear to be increased (unpublished). Our preliminary data on tissue uptake of ascorbic acid suggest that changes in tissue distribution are one possible answer for the observed effects of the steroids on blood levels of ascorbic acid.

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease). An electron microscopic study of the vascular lesions before and after therapy with hormones

Eight patients with hereditary hemorrhagic telangiectasia and severe epistaxis were treated with norethynodrel with mestranol (Enovid). Biopsy specimens of typical lesions from two patients were taken for electron microscopy before and after several months of therapy. Characteristic endothelial cell damage and nectosis were noted in the dilated venules of patients before treatment but not after. Unlined channels of blood were found in connective tissue before treatment but not after. These are thought to arise from leaks in the affected venules, and it is suggested that later indothelial ingrowth gives rise to the propagation of lesions that are known to develop with age. Reduplicated basal laminae and regenerating endothelial cells were found both before and after treatment.

Effect of ethynodiol diacetate and mestranol on serum folic acid and vitamin B12 levels and on tryptophan metabolism in baboons

The effect of an oral contraceptive agent on serum folate and vitamin B12 levels and on some aspects of tryptophan metabolism in the baboon has been investigated. Folate levels were not affected by this treatment. Vitamin B12 levels were lowered during oral contraceptive treatment (P smaller than 0.1) and increased during a 30-day period of pyridoxine supplementation (P smaller than 0.01). Trends indicating deterioration of glucose tolerance and abnormal tryptophan metabolism were also observed. Definite conclusions concerning the effect of oral contraceptive agents on nutritive parameters could not be made. This is in keeping with the vast volume of literature published on the effects of oral contraceptive agents in humans and other species. It is concluded that perhaps, due to the biologically variable responses to oral contraceptive agents by individuals of any species, studies of serum levels of vitamins and other superficial biochemical parameters. Further, we conclude that the baboon could be a useful model for the study of endocrine influences on nutritive parameters, first because endocrine parameters resemble those of humans and second, because experimental protocols can be rigidly adhered to.

Effect of oral contraceptive agents on the metabolism of some trace minerals

Biochemical and metabolic alterations noted in women taking the oral contraceptive agents have included changes in blood levels of some trace minerals. Only a few of these, namely, iron, copper and zinc, have been studied. This paper intends to review the changes reported and outline the beginning of a series of studies to attempt to determine whether there is any metabolic significance to these alterations. The alterations reported in blood levels are generally believed to be related in large measure to alterations in levels of specific "transport" proteins induced primarily by estrogen. The significance of these changes is generally unknown, however, they involve slight elevations in serum iron and copper and possibly a reduction in serum zinc, although these are not as clear-cut as those of the other two trace minerals. In an attempt to determine whether any metabolic significance could be attributed to these changes, several studies have been instituted. The first, reported in this paper, consisted of a metabolic study on a group of seven women aged 18-32 who had been taking oral contraceptives for at least 3 years. The subjects were studied over four metabolic periods for a total length of 116 days. They were studied in a random fashion, generally 2 months on and 2 months off the pill, although this varied slightly. The subjects were fed a controlled formula diet throughout this study and vitamins and trace minerals, other than copper, iron and zinc, were given orally in capsules. A trace mineral solution was administered so that the total daily iron, copper and zinc could be fed in four equal feedings per day with the formula. Measurements consisted of studies of the blood levels of the trace minerals as well as their binding proteins, various indices of blood chemistry to assess health, hematological indices and total balance studies for each of the trace minerals and nitrogen. The balance studies included not only urine and fecal loss but also skin, menstrual and hair losers. Preliminary results are discussed as well as the formidable problems involved in trace mineral studies in humans. These problems are not only related to contamination but also are analytic in nature.

The feedback effects of sex steroid hormones on pituitary gonadotropin release in Turner's syndrome and Klinefelter's syndrome

The present study was designed to elucidate the feedback relationship between the release of pituitary gonadotropins and sex steroid hormones in Turner's syndrome and Klinefelter's syndrome. LH-RH stimulation test was employed to evaluate the effects of sex steroids on the release of gonadotropins. The release of gonadotropins in response to LH-RH as well as in baseline level was suppressed after the treatment with estrogen (mestranol 0.08 mg/day) for 10 days, followed by the treatment of the same period with estrogen (mestranol 0.08 mg/day) and progesterone (chlormadinone acetate 2.0 mg/day) in combination in both syndromes. The inhibitory effect of the combined treatment was greater than that of the treatment with estrogen alone. Administration of testosterone propionate (25 mg/day) for 3 days resulted in suppression of the release of both gonadotropins in baseline level and in response to LH-RH in both syndromes, but the suppressive effect appeared to be less complete as compared with that of estrogen or estrogen-progesterone. It was thus verified that the feedback interaction between the pituitary gonadotropin release and sex steroids such as estrogen, estrogen-progesterone or testosterone was operative in the same fashion in the patients with Turner's syndrome and Klinefelter's syndrome.

Effect of oral contraceptive agents on nutrients: II. Vitamins

Clinical, biochemical and nutritional data were collected from a large population of women using oral contraceptive agents. Higher incidence of abnormal clinical signs related to malnutrition were observed in the lower (B) as compared to the higher (A) socioeconomic groups, and also in the nonsupplemented groups as compared to the supplemented groups in the B subjects. As a rule the intake of oral contraceptive agent subjects of vitamin A, C, B6 and folic acid did not differ from that of the controls As expected, subjects from the supplemented groups had higher intake of vitamin A, C, B6, thiamin, riboflavin and folic acid, and A groups had higher intake of vitamin C, B6, riboflavin and folic acid. Increased plasma vitamin A and decreased carotene levels were observed in oral contraceptive agent users. In general oral contraceptive agents had little or no effect on plasma ascorbic acid. Urinary excretion of both thiamin and riboflavin in subjects using oral contraceptive agents were lower in A groups. Erythrocyte folate and plasma pyridoxal phosphate was decreased in A groups due to oral contraceptive agents. Subjects who took supplements had higher levels of plasma vitamin A, ascorbic acid and folate. But urinary thiamin and riboflavin were higher only in group A subjects who took supplements.

[Contraceptive activity of combinations of steroids and antiadrenergic preparations]

Experiments were conducted on mature female rats. Simultaneous administration through a tube for 14 days, daily, of mestranol (0.04 mg/kg) and megestrol acetate (0.8 mg/kg) gave no significant contraceptive effect, whereas the use of steroid preparations in the same doses in combination with antiadrenergic substances--dopegit (100 mg/kg) or pyrroxan (10 mg/kg) prevented pregnancy effectively.

Effect of oral contraceptive agents on nutrients: I. Minerals

The epidemiological aspects of oral contraceptive agents on nutrient metabolism were studied in a large population of women. Incidence of clinical abnormalities, related to malnutrition, were more frequently observed in the lower (B) as compared to the higher (A) socioeconomic groups. In the A groups some clinical signs were more common in the nonsupplemented groups of subjects. In general, the intake of oral contraceptive agent subjects for calories, protein, calcium, magnesium, iron, copper and zinc did not differ from the controls. The intake of the above nutrients in group A subjects were higher than those of group B except for calories. The subjects who took supplements had higher intakes of calcium, iron, magnesium and copper. No effect of oral contraceptive agents was seen on hemoglobin, hematocrit and erythrocyte count. Serum iron was increased due to "Norinyl." Total iron binding capacity was increased as a result of oral contraceptive agent administration. Total iron binding capacity values were higher in group B as compared to group A and in the nonsupplemented as compared to the supplemented groups. Plasma copper was increased and plasma zinc was decreased as a result of oral contraceptive agent administration. An increase in erythrocyte zinc was observed due to "Norinyl." No effect of oral contraceptive agents on plasma calcium, magnesium and erythrocyte magnesium was observed. Although no effect of oral contraceptive agents on plasma total protein was found, serum albumin was decreased.

Gonadotropin responses following luteinizing hormone releasing hormone administration in normal subjects

Synthetic luteinizing hormone releasing hormone (LHRH), 100 mug, was administered intravenously to 29 normal individuals. In male subjects, both baseline and peak LH response values showed minimal variations between subjects. The FSH baseline and response were more variable. In normal females the FSH and LH baseline values and response to LHRH infusion showed greater variation than that seen in male subjects, and this variation correlated with the phase of the menstrual cycle. In perimenopausal women with elevated baseline gonadotropins, the absolute LH peak values were comparable to those seen during the periovulatory period of the menstrual cycle, while FSH baseline and peak values were unmistakably higher than those observed in the normally menstruating women. Three women under gonadotropic suppression by three different drugs were investigated; megestrol suppressed the LHRH response more effectively than either diethylstilbestrol or an oral contraceptive. The LHRH stimulation test reflects only the ability of the pituitary cell to release gonadotropins. In a normal individual, however, some justifiable assumptions can be made regarding the immediate past synthesis and release versus accumulation of pituitary LH.

Effect of ethynodiol diacetate and combination--type oral contraceptive compounds on carbohydrate metabolism. I. Six month intravenous glucose tolerance study

In order to evaluate long-term effects of different types of oral contraceptive compounds, blood glucose and plasma insulin levels were measured during an intravenous glucose tolerance test in 2 groups of normal, nondiabetic patients: 36 women using a progesterone-alone oral contraceptive, ethynodiol diacetate, and 36 women using a combination-type drug, containing norethynodrel and mestranol. Each patient was tested before and after 6 months of treatment. There were no significant differences from pre-treatment glucose and insulin values in the first group of women (on ethynodiol diacetate). In the second group (on norethynodrel and mestranol), there was a significant elevation of mean blood glucose levels at 15, 30 and 120 min of the glucose tolerance test. Nevertheless, a significant elevation of plasma insulin was seen only at 60 min of the test. Patients participating in this study will continue this treatment, and monitoring of carbohydrate metabolism is contemplated over a period of several years.

Inhibition of cyclic gonadotropin secretion by endogenous human prolactin

The resumption of cyclic uterine bleeding reportedly accompanies the use of human prolactin (HPRL)-suppressing agents in postpill galactorrhea-amenorrhea. In this laboratory, HPRL suppression with L-dopa was variable and short lived. Basal plasma HPRL levels were elevated before and after as much as five months of therapy. Galactorrhea persisted and mean gonadotropin concentrations were subnormal. An immediate and sustained attenuation of HPRL secretion ( less than 200 per cent) followed the use of 2-Br-alpha-ergocryptine (CB-154). Cyclic gonadotropin secretion resumed and was accompanied by ovulation and, in one instance, pregnancy. The cessation of galactorrhea was positively correlated with the rise in the daily concentration of 17 beta-estradiol. Cyclic postovulatory menstruation continued after the cessation of CB-154 treatment. HPRL levels remained normal. The daily patterns of human follicle-stimulating hormone (HFSH) and human tuteinizing hormone (HLH) secretion created by the suppression of HPRL displayed an inherent rhythmicity identical to that observed at the time of menarche. The inhibitory effects of HPRL appeared directed at cyclic rather than tonic gonadotropin secretion. At the same time, diminished ovarian estrogen production seemed to increase mammary gland sensitivity to HPRL, leading to lactation. One may postulate, therefore, that the ingestion of sex steroids is associated with an over-all suppression of endogenous cyclic and, to a lesser extent, tonic gonadotropin secretion secondary to which ovarian function is attenuated. Without physiologic concentration of circulating estrogen, HPRL induces mammary alveolar function with the production of a milklike secretion.

The effect of oral contraceptives on folate metabolism. III. Plasma clearance and urinary folate excretion

The plasma clearance of folic acid (PGA) and urinary excretion of folates were determined in women on oral contraceptives and in control subjects. The initial phase of plasma clearance of PGA (first 5 minutes) was much faster in oral contraceptive users than in the controls, but the subsequent rate of clearance was the same in the two groups. There was a good correlation between the 12-hour urinary folate excretion and serum or red cell folate in both groups. The women on oral contraceptives excreted more folate in their urine for any given level of serum or red cell folate. The increased urinary folate excretion may partly explain the lower serum and red cell folate in oral contraceptive users.

Estrogen potency of oral contraceptive pills

The estrogen potencies of 9 oral contraceptive pills, Enovid-E, Enovid-5, Ovulen, Demulen, Norinyl+80, Norinyl+50, Ovral, Norlestrin 1 mg. and Norlestrin 2.5 mg., were determined by bioassay. Relative estrogen potency was determined by analysis of variance. Enovid-5, the most estrogenic compound, had a potency of 4.88 compared to ethinyl estradiol, 50 mcg. equal 1.00; Ovral, the least estrogenic compound, had a potency of 0.81, a sixfold difference. Estrogen potencies at a fractional dose of 0.00155 correlate with reports of the incidence of minor side effects and thromboembolic disease. The effect of progestins on estrogen potency was purely additive (norgestrel and norethynodrel), purely antagonistic, or additive at low concentrations and antagonistic at high concentrations (norethindrone, norethindrone acetate, and ethynodiol diacetate). These results suggest that pills with a greater margin of safety might be developed by utilizing greater ratios of progestin to estrogen. In addition, differences in relative estrogen potency of oral contraceptive pills may be used as a basis for better clinical selection.

Potentiation of hypothalamic pressor responses in awake rats treated with contraceptive steroids

Contrasting with the hypertension resulting consistently after DOCA implantation, mature female rats given Enovid daily for 20 weeks had only slight and occasional increases in blood pressure. The pressure elevations remained infrequent and transient even when drinking water was replaced with isotonic saline solution but they became more pronounced when Enovid treatment was initiated at an earlier age. Despite the failure to cause sustained hypertension, the data indicate that Enovid affects blood pressure and that both mestranol and norethynodrel are essential for this effect. Pressor responses to norepinephrine or angiotensin were unaffected even after 20 weeks of pretreatment but those to electrical stimulation of the posterior hypothalamus were increased in rats pretreated with Enovid. Enhanced responsiveness to hypothalamic stimulation occurred only in the awake state and was not demonstratable after the central nervous system (CNS) had been depressed with urethane. These results can be explained by an increased sensitivity of hypothalamic pressor areas produced by Enovid prior to the development of hypertension and the mechanisms involved may be similar to those occurring in spontaneously-hypertensive rats. However, the possibility of hypersensitivity at other sites in the sympathetic vasomotor outflow cannot be ruled out.

The metabolism of synthetic estrogens in non-users and users of oral contraceptives

Using both pulse injections and constant infusions of 3-H-mestranol (3H-ME) (1) and 3-H-ethinyl estradiol (3H-EE) we have studied the metabolism of these compounds in non-users and users of oral contraceptives. Following pulse injection of 3-H-ME the disappearance of radioactivity could be described as a function which was the sum of two exponentials. Studied by both types of administration there was no difference in the metabolism of 3H-ME in the two groups; the overall mean plus or minus SE metabolic clearance rate (MCRM) was 690 plus or minus 45 1/day/m2, the mean ratio of the concentrations of radioactivity as EE following administration of ME (CRM-BB,E) was 0.23 plus or minus 0.02 and the mean (p)M,EBB (fraction of administered ME measured in blood as EE) was 0.19 (95% confidence limits equals 0.15 - 0.23). Following pulse injection of 3-H-EE the disappearance of radioactivity was best described as a function which is the sum of three exponentials. Results from both types of administration revealed no difference in the metabolism of 3H-EE between non-users. The overall mean plus or minus SE MCREE was 630 plus or minus 30 1/day/M2. The MCREE is significantly (0.02 greater than P greater than 0.01) less than the mean MCR for estradiol reported previously, in both non-users and users of oral contraceptives. The use of oral contraceptives containing estrogens and progestins does not appear to influence the metabolism of the estrogen used. Approximately 20% of mestranol is converted to and appears in the blood as ethinyl estradiol.