The influence of oral contraceptives on the postmolar human chorionic gonadotropin regression curve

This article reports a retrospective analysis of 149 evaluable cases of molar pregnancy managed at Women's Hospital, Los Angeles County/University of Southern California Medical Center, from January 1977, through June, 1983. In the 84 cases prior to 1981, the patients received estrogen-progestogen oral contraceptives after evacuation while the 55 patients seen after that used nonhormonal contraceptives. The frequency of abnormal regression of the serum beta-subunit of human chorionic gonadotropin in the two groups was not significantly different (22.6% in the hormonal contraception group versus 34.5% in the nonhormonal contraception group). The groups were compared for known and potential risk factors and were nearly identical with respect to patient age, parity, maternal blood type, and race. There were also no significant differences with respect to uterine size, preevacuation beta-subunit of human chorionic gonadotropin serum titer greater than 100,000 mIU/ml, and frequency of theca-lutein cysts. Gestational age was significantly shorter and the frequency of cases with a preevacuation beta-subunit of human chorionic gonadotropin serum titer greater than 250,000 mIU/ml significantly higher in the nonhormonal contraception group, indicating that the nonhormonal contraception group had a higher risk for abnormal human chorionic gonadotropin regression than the hormonal contraception group. We conclude that this study provides no evidence that the use of estrogen-progestogen oral contraceptives prior to human chorionic gonadotropin remission increases the risk for invasive mole or choriocarcinoma following molar pregnancy.

[Immunogenicity of synthetic sex hormones and thrombogenesis]

The ingestion of synthetic steroidal and non-steroidal estrogens may induce antiestrogen antibodies in women on oral contraceptives, and in prostatic patients treated with diethylstilbestrol (DES). Natural sex hormones have no such effect. A radioimmunoassay with tritiated ethinylestradiol or DES was applied to study the prevalence of synthetic sex hormone antibodies in 2 populations: 100 women on estroprogestative hormones and 93 cases of DES treated prostatic cancers. Homologous non-treated controls were compared. Results allowed to identify among treated and asymptomatic subjects an immunoreactive population of 30% women and 47% men. Furthermore, the antibodies were found with a much higher frequency (p less than 0.001) in patients who had experienced a thromboembolic disease while on treatment: 90% of women and 74% of men. The importance of these antibodies as a risk factor, their possible role in promoting vascular lesions, the interest of their detection for the prevention of the vascular risk induced by synthetic sex hormones, are considered.

Iron stores in users of oral contraceptive agents

A comparison of serum ferritin and other parameters of iron status was made between 46 women taking oral contraceptive agents (OCAs) for two or more years continuously and 71 women who never took OCAs. The mean serum ferritin level for the OCA users was 39.5 +/- 21.5 ng/ml and the control group mean level was 25.4 +/- 15.96 ng/ml, which is significantly different at p less than 0.001. Serum transferrin, serum iron, TIBC, MCH and MCHC levels were significantly greater for the OCA users group. Significantly lower RBC and hematocrit levels were found for OCA users while other parameters, hemoglobin, MCV and percent transferrin saturation, were not significantly different. No major differences in subject characteristics and dietary traits were evidenced, except a difference in reported menstrual cycle losses and a higher heme iron content in the diet of the OCA users.

A clinical study on injectable contraceptive Noristerat

Results of a clinical study involving 382 subjects using the injectable contraceptive Noristerat (norethisterone enanthate) is presented. The maximum number of acceptors were between 21-25 years of age and had been married for 6-10 years. 50% began their 1st injection within 1 year of the last childbirth. Continuation rates were very high and about 75% returned for their 2nd injection. Among the users, weight gain was seen more commonly than weight loss. There was no significant change in blood pressure. 52.2% reported a menstrual pattern which was within the acceptable range of normal, while only 12.7% had amenorrhea. 15% showed other types of menstrual disturbance. Only 1 woman in the series became pregnant. Menstrual abnormality was the most common cause for discontinuation among the 71 subjects available for interview.

Risk factors for gestational trophoblastic disease in Italy

Between June 1981 and March 1983, data were collected to assess risk factors for gestational trophoblastic disease in a case-control study of 100 women with trophoblastic tumors (17 partial hydatidiform moles, 63 complete moles, and 20 choriocarcinomas) and 200 age-matched controls admitted for normal deliveries to university or general hospitals in Lombardy, Northern Italy. Questions were asked about each patient's general life-style, and medical, obstetric, menstrual, contraceptive, and social history. The risk of trophoblastic disease increased with increasing paternal age: women whose husbands were aged 40-44 years and 45 years or more had a relative risk of 2.4 and 4.2, respectively, compared to women married to men aged under 40 years. This association was independent of maternal age. Cigarette smoking was associated with trophoblastic tumors (relative risk estimate for smokers vs. never smokers = 2.0, 95% confidence interval = 1.2-3.2), the risk being greater for women who smoked more cigarettes and for longer. The effect of cigarette smoking was not explained by any other identified potential distorting factor. A positive history of fertility problems or difficulties in conception and a personal or family history of gestational trophoblastic disease were more common among the cases. Past use of oral contraceptives was not related to the risk of trophoblastic tumors, but use of an intrauterine device was significantly more common among the cases. The findings give epidemiologic support to the evidence of an androgenetic role in the origin of hydatidiform mole; moreover, they provide new hypotheses on the risk factors for gestational trophoblastic disease in developed countries. Further exploration of these factors may lead to a more coherent body of evidence on the etiology of these diseases.

Are there adverse effects of periconceptional spermicide use?

Recent studies have suggested that spermicide exposure around conception may cause congenital malformations, reduced birth weight, or spontaneous abortion. This large, prospective study examined the risk for multiple malformation, patterns of malformations, low birth weight, preterm delivery, and spontaneous abortion in infants whose mothers used spermicides only before or after their last menstrual period, compared with a control group using other contraceptive methods. The multiple malformation rates in women using spermicides only before or after their last menstrual period were 3.8 and 4.8 per thousand, respectively. For the control groups, the corresponding rates were 5.4 and 6.4 (not significant). No pattern of malformations was found in spermicide-exposed infants. The risk of preterm delivery, the risk for producing a low-birth-weight (less than 2500 gm) infant, and the risk of spontaneous abortion were no higher in women exposed to spermicides than in women using other methods of contraception. This study finds no evidence that spermicide exposure around the time of conception is dangerous to the fetus.

The effect of low-dose estroprogestinic preparations on prothrombin complex factors: no significant increase after an 8-month trial

The behavior of the prothrombin complex factors in 16 healthy women during low-dose estroprogestinic treatment (laevonorgestrel 0.15 mg and ethynilestradiol 0.30 mg) at basal conditions and during 8 months of therapy has been investigated. We found a statistically significant decrease of the PTT (Partial Thromboplastin Time). The prothrombin time, on the other hand, became slightly decreased, but not to a statistically significant extent. Among the prothrombin time derived tests for evaluating the prothrombin complex only the PP test (Prothrombin Proconvertin test) was significantly shortened. Of the coagulation factors (factors II, VII and X) only a modest, but not statistically significant, increase in Factor VII and Factor X was noted. We conclude that, during the 8 month observation period, prothrombin complex factors are not altered substantially.

Spermicidal contraceptives and poor reproductive outcomes: the epidemiologic evidence against an association

The first widely publicized report of an association between spermicidal contraception and congenital malformations and spontaneous abortion had considerable impact on obstetric practice. A large number of more recent epidemiologic studies have generally failed to support the earlier finding, and it is concluded that no such association has been demonstrated. The available evidence precludes the need for additional regulation of spermicidal contraception.

Reproductive and hormonal factors and breast cancer in a Northern Italian population

Between January 1980 and March 1983, data were collected to evaluate risk factors for breast cancer in a case-control study based on 368 women with breast cancer admitted to the General Hospital of Pordenone (a district in North Eastern Italy with a particularly high breast cancer mortality rate), and 373 age-matched controls. Nulliparity or low parity, late age at first birth and later menopause were associated with an increased risk of breast cancer. The elevated risk associated with nulliparity could be almost completely explained by marital status, thus pointing to a specific protection given by parity, rather than some putative influence of infertility or subfertility in breast cancer cases. Likewise, risk did not vary materially according to history of abortions when marital status was controlled for. Increased risk associated with later age at first birth, on the other hand, was not accounted for by marital status or parity. The population studied, though frequently multiparous, showed late average at first birth: this might, at least partly, explain its high mortality rate from breast cancer. The risk estimate was higher if menarche occurred below age 15; however, there was no evidence of a trend for the relative risk to rise with lower age at menarche. The use of oral contraceptives or other female hormones (such as oestrogen replacement therapy) did not appear to be related to the risk of breast cancer. The role of the major menstrual and reproductive variables considered (age at menarche, parity, age at first birth) was apparently stronger in pre-menopausal women, thus suggesting an influence of these factors (and possibly, their hormonal correlates) on one of the latter stages of the process of carcinogenesis.

Problems in specimen collection for sexually transmitted diseases

Laboratory methods for the diagnosis of sexually transmitted diseases (STDs) are continuously undergoing improvement. It remains the responsibility of the clinician to become familiar with the tests available for the diagnosis of STDs. Those tests depend on obtaining clinical specimens from the proper site and on transporting them to the laboratory under satisfactory conditions.

Determination of reference intervals for 10 serum proteins measured by rate nephelometry, taking into consideration different sample groups and different distribution functions

Reference intervals were established for 10 serum proteins (IgA, IgG, IgM, transferrin, haptoglobin, complement C3, complement C4, alpha 1-acid-glycoprotein, alpha 1-antitrypsin, alpha 2-macroglobulin) measured by rate nephelometry. The reference individuals - 200 blood donors - were divided into 5 subgroups: men aged 19-39 and 40-60 years, women aged 19-39 and 40-60 years and women aged 19-48 years using oral contraceptives. Where possible, two or more subgroups were combined to give reference sample groups. Criteria for this procedure are given. The reference limits of the sample groups were estimated by parametric methods. Assuming that for a specified serum protein the type of distribution is the same in each subgroup, the data were standardized with estimated group specific parameter values and combined into one big sample. This permitted an improved determination of the underlying type of distribution. As a possible form of distribution we also considered the normal distribution truncated on the left side at c greater than or equal to 0. In some cases, after determination of an optimal c, this unusual distribution fitted the data significantly better than the generally used normal or log-normal distribution.

[Estrogen and progesterone receptors in the decidual tissue of women administered prostaglandins and experiencing spontaneous abortion]

A study was made of the content of estrogen and progesterone receptors (ER and PR, respectively) in the cytosol and nuclei of the decidual tissue of women in induced and spontaneous abortion at 7-12 week pregnancy. Abortion was done surgically (control group) and in preliminary cervical dilatation with the help of intravaginal suppositories with a synthetic prostaglandin analog of E1-16.16-dimethyltrans-delta 2-PGE1 (ONO-802) group or laminaria. The level of ER in the cytosol and nuclei of the decidual tissue of the control group was twice as low as that of PR, and the ER/PR ratio in cell fractions as well as in general cell receptors was 0.58 +/- 0.09, 0.42 +/- 0.07 and 0.56 +/- 0.07, respectively. The suppositories with ONO-802 caused a statistically significant decrease in the PR content in each of the cell fractions and cytoplasmic ER resulting in an increase in the ER/PR ratio to 0.87 +/- 0.06 (P less than 0.05) in the cytosol, 0.09 +/- 0.24 (P less than 0.05) in the nuclei, and 0.86 +/- 0.8 (P less than 0.05) in the total cell. A decrease in the PR level in both cell fractions and the ER level in the fraction of the nuclei with an acute increase in the content of cytoplasmic ER was marked in spontaneous abortion. The ER/PR ratio also rose to ER and was 1.98 +/- +/- 0.2 (P less than 0.001) in the cytosol and 1.02 +/- 0.16 (P less than 0.05) in the total cell. It was concluded that an absolute and/or relative decrease in the PR level plays an important role in mechanism of abortion.

A comparison of high-dose estrogens versus low-dose ethinylestradiol and norgestrel combination in postcoital interception: a study in 493 women

Ethinylestradiol (EE), at a dosage of 5 mg/day for 5 consecutive days (5 mg EE), has generally been used for interception. A combination of 200 micrograms EE and 2 mg dl-norgestrel (EE + NG) was proposed as an effective alternative. Efficacy and tolerance of these methods were compared in a randomized, double-blind study. A group of 465 women was studied with a follow-up rate of 94.3%. In the 5 mg EE group a pregnancy rate of 0.9% was observed, and in the EE + NG group a rate of 0.4% was found. These rates differ significantly from the expected rates (P less than 0.0005, in both series). Nausea was noted in 59.1% of the 5 mg EE group and in 54.0% of the EE + NG series. Nausea and vomiting occurred in 20.8% and 15.8%, respectively. The efficacy of both methods as alternative morning-after medication was confirmed. The new method is preferable because treatment is limited to only 1 day.

The effect of oral contraceptive formulation and field-workers: a cautionary tale

This paper examines oral contraceptive continuation rates and reported side effects in a large scale clinical research project conducted in Sri Lanka. The project evaluated standard- and low-dose pills used with and without vitamin supplements. Differences in continuation rates and perception of side effects are used to illustrate the impact that family planning field-workers can have on women's use of oral contraceptives.

Effect of reserpine on fertilizing capacity of human spermatozoa

The effect of reserpine at various concentrations (2 X 10(-6), 2 X 10(-7), 2 X 10(-8), 2 X 10(-9) and 2 X 10(-10) M) on the in vitro fertilizing capacity of human spermatozoa was studied. Spermatozoa collected from presumably fertile men were washed in BWW medium and incubated with different concentrations of reserpine for 5 hr before insemination of the zona-free hamster ova. The spermatozoal penetration of the zona-free hamster ova was scored 6 hr later and the results were analyzed statistically. Reserpine, at all the concentrations tested, caused a significant dose-dependent decrease in the penetration of the denuded hamster ova in comparison to the control (p less than 0.05). The percent motility of spermatozoa decreased as a function of time during the preincubation period to initiate spermatozoal capacitation but there were no significant differences in the values between the control and the reserpine - treated spermatozoa (p greater than 0.05). These findings indicate that reserpine can affect the fertilizing capacity of human spermatozoa in vitro and provide an additional evidence to suggest the prospective use of reserpine as a vaginal contraceptive.

Low-dose oral contraception and blood pressure in women with a past history of elevated blood pressure

Sixty-one women with a past history of elevated blood pressure (high-risk group) associated with oral contraceptive use (27 patients), unknown etiology (17 patients), or preeclampsia (17 patients) used a low-dose oral contraceptive containing 0.4 mg of norethindrone and 35 micrograms of ethinyl estradiol for 3 to 24 months. The highest blood pressures recorded in the past were 141.0 +/- 14.9 (mean +/- SD) mm Hg systolic and 98.3 +/- 8.0 diastolic. Sixty-one women without a past history of elevated blood pressure (low-risk group), selected from a pool of 616 low-risk patients, were matched with the high-risk group for race, initial age, initial body weight, duration of use, history of smoking, and family history of hypertension. The blood pressures in the high-risk group before and after oral contraceptive therapy were significantly higher than those in the low-risk group. Despite these differences, the mean systolic and diastolic blood pressures in these two groups of women using the low-dose oral contraceptive did not rise when compared with their own baseline blood pressures. Five high-risk patients (8.2%) discontinued therapy because of the redevelopment of hypertension; however, blood pressures at discontinuance were comparable to the previous highest blood pressures.