'Patient failure' as a reliability model for the 'minipill': a clinical study

A trial was carried out in 10 healthy women to study the effects of withdrawal of treatment with 0.5 mg lynestrenol per day, for 3 successive days during the pre-ovulatory phase, on the physiological properties of the cervical mucus, vaginal cytology and pituitary and ovarian functions. In most cases, the amount, Spinnbarkeit and ferning of the cervical mucus and sperm penetration remained the same as that before interruption of treatment. In 2 women, the ferning altered to 'good' for 2 to 3 days as the amount of mucus increased slightly. Spinnbarkeit increased at the same time and sperm penetration was good. The changes in LH and FSH excretion suggested that ovulation possibly took place in 1 of the women studied. A mid-cycle oestrogen peak was seen in 2 women. No side-effects were reported during the study apart from irregular intermenstrual bleeding in 1 woman.

[Results of in vitro sperm penetration tests in cervical mucus under takings of the sequential oral contraceptive ovanon and sequilar (author's transl)]

The in vitro penetrability of cervical mucus by sperm was investigated in women who were taking Ovanon or Sequilar. Measurements were made under constant experimental conditions on every day of the cycle. The depth of penetration differed strikingly between women with normal menstrual cycles and women taking the sequential hormonal contraceptives. The penetration depth was substantially less when Sequilar or Ovanon was used. The Sequilar induced cervical sperm barrier during the entire cycle was almost as strong as that observed when combined preparations are used. During the proliferative phase of the cycle the penetration depth allowed by Ovanon was less than that observed during normal cycles but greater than that seen with Sequilar. During the secretion phase no appreciable differences in the penetrability of cervical mucus between the two contraceptives was observed. The hypothetical relationship between these data and the problem of cervical carcinoma was described.

Effects of orally administered oestradiol decanoate on plasma oestradiol, oestrone and gonadotrophin levels, vaginal cytology, cervical mucus and endometrium in ovariectomized women

Six ovariectomized women with the uterus left in situ were given a daily oral dose of 0.5 mg of oestradiol decaneoate in oil for 14 days. After a single dose of oestradiol decanoate mean plasma oestradiol rose from 26.8 pg/ml to 66.8 pg/ml within 30 min. There was a further rise to 100-110 pg/ml (P less than 0.001) remaining at the same level over a 24 h period. On repeated daily administration of oestradiol decanoate this rise continued reaching the mean value of 187.1 pg/ml (P less than 0.001) at 2 weeks, while plasma oestrone remained at the same level (147.1 pg/ml) as it was at 24 h. The ratio of plasma oestrone:oestradiol was less than 1 at 2 weeks. Plasma FSH and LH fell progressively during the medication. Changes of the Maturation Index, cervical mucus Ferning and Spinnbarkeit demonstrated the strong 'peripheral' activity of this dose of oestradiol decanoate. All endometrial specimens showed late proliferative changes at 2 weeks. It was concluded that the favourable properties of oestradiol decanoate offer new possibilities for a more physiological oestrogen supplementation therapy.

Experimental and clinical data on Cyclabil

The effects of a 2-phase preparation on the parameters of cycle function were studied in 14 normally menstruating women. The preparation, Cyclabil, is administered in a series of 11 tablets with 2.0 mg oestradiol valerate and 10 tablets with 2.0 mg oestradiol valerate in combination with 0.5 mg D,L-norgestrel. The cervical function, the spinnbarkeit of the cervical mucus and its crystallisability and, by means of RIA, FSH, LH, 17beta-oestradiol and the progesterone serum levels were determined continuously in a control cycle before the treatment, in the first and third treatment cycles and in a subsequent control cycle. The results show that no impairment of the normal cycle function were found during cyclical administration of the 2-phase preparation in 13 women. Two pregnancies occurred during the therapy. The process of ovulation was inhibited in one subject during the medication. 20 other women with pronounced premenopausal deficiency symptoms and cycle irregularities were treated with the 2-phase preparation for 6 months. Apart from the good cycle regulation, the deficiency symptoms were eliminated completely in 19 women and almost completely in 1 woman. Checks of the FSH, LH, 17beta-oestradiol and oestrone serum levels conducted at random during a medication cycle showed only a slight influence on the gonadotropin level. During the medication, E2 can be demonstrated in comparison to E1 at a ratio of 1:10.

Studies on low-dose oral contraceptives: cervical mucus and plasma hormone changes in relation to circulating D-norgestrel and 17alpha ethynyl-estradiol concentrations

A study was undertaken to determine the effects of a low-dose oral contraceptive comprising 150 mug of D-norgestrel and 30 mug of 17alpha-ethynyl estradiol (Microgynon) on the plasma levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17BETA-ESTRADIOL, AND PROGESTERONE AND ON THE PHYSICAl properties of cervical mucus. Samples of blood and cervical mucus were obtained from three women during a treated cycle and the immediately-following "withdrawal" cycle. Specific radioimmunoassay methods were used to determine LH, FSH, 17beta-estradiol, and progesterone levels in treated and withdrawal cycles, and D-norgestrel and 17alpha-ethynyl estradiol in samples obtained during treated cycles. The concentration of synthetic steroids was also measured in blood samples obtained before and 1 hour after ingestion of the contraceptive to determine the maximal daily variation. The results indicated that the contraceptive action of this combined low-dose oral contraceptive is mediated through suppression of ovulation and by rendering the cervical mucus impenetrable to sperm. Plasma FSH levels appeared to be one of the most sensitive indices of suppression. Determination of D-norgestrel and 17alpha-ethynyl estradiol showed that 3 to 4 days were required to reach maximal plasma levels and that daily fluctuations were considerable. Withdrawal of the pill resulted in an immediate return to ovulatory cycles in all three subjects studied.

[The low dosis gestagen therapy (author's transl)]

In young women aged 22-34 years the hormone profile under continuous therapy with 0.5 mg lynestrenol/day have been investigated. Estradiol, progesterone and FSH values have been determined in plasma by the RIA or protein-binding method, whereas LH excretion was daily measured in the urine starting on the 5th day of cycle. The low-dose-gestagen therapy shows all possible hormonal patterns ranging from the ovulatory to anovulatory one. The estradiol-17 B values in half of the patients were higher than in the cycle preceding treatment. In the first few treatment cycles all women showed markedly decreased progesterone values. However, this defect seems to recover and return to normal in later cycles. In order to be able to further explain the alterations occurring during the luteal phase under the treatment with 0.5 mg/day of lynestrenol, ovarian tissues wedge resection of women undergoing gynecological surgery has been examined macroscopically and microscopically. At the same time the hormonal profile has been determined in plasma. These investigations revealed that the morphological alterations in the ovary proceed in an unchanged way under the mentioned treatment. Histologically it could be demonstrated that ovulation is delayed by several days. The histological findings of tubal tissue (from patients who underwent sterilization) showed that the secretional activity of the tubal epithelium is considerably decreased and ciliogenesis increased. In our clinical study neither tablet nor patient failures occurred. With the exception of cycle- and tempo-disturbances no severe adverse reactions were reported. Breakthrough bleedings and spotting as well as amenorrhea in most cases manifested already in the first treatment cycles. It is important that the daily tablet is taken at midday because the maximum effect on the cervical mucus of the mini-pill therapy is most pronounced 4-6 hours after tablet intake. Especially in young patients it is recommended to get written reports on tablet intake. The strict following of these directions mainly guarantees a successful mini-pill therapy.

Lack of evidence for inhibition of ovulation by aspirin in women

Prostaglandin synthetase inhibitors such as aspirin and indomethacin inhibit ovulation in experimental animals. The effect of therapeutic doses of aspirin on ovulation has been studied in 5 women. Ovulation, as assessed by measurements of urinary LH and plasma progesterone levels, basal body temperature and cervical mucus changes occured in all the control and treatment cycles. Serial sections of the corpora lutea failed to show any entrapped ova. The significance of finding a prostaglandin synthetase inhibitor which acts specifically at the ovarian level is discussed.

The effect of daily norethisterone (0.35 mg) on cervical mucus and on urinary LH, pregnanediol and oestrogen levels

The effect of 0.35 mg of norethisterone daily on cervical mucus and on urinary LH, pregnanediol and oestrogen levels was studied during two treatment cycles in five subjects who had been observed during a control cycle. Variable changes in hormone excretion patterns were found and are discussed.