Ovarian morphologyy after prolonged use of steroid contraceptive agents

Suppression of reproductive function in autoimmune NZB/W mice: effective doses of four contraceptive steroids

Oral contraceptives have been implicated in causing flares of systemic lupus erythematosus in humans, and studies of these agents in the NZB/W mouse model of lupus may help to elucidate mechanisms responsible for disease activation. To define doses which effectively suppress reproductive function in NZB/W mice, we implanted groups of NZB/W females with Silastic capsules containing increasing doses of four compounds: norethindrone (NE) 0.5-5.0 mg, norgestrel (NG) 1.0-7.5 mg, medroxyprogesterone (MP) 0.5-20.0 mg, and ethinyl estradiol (EE) 0.5-5.0 mg. Controls received empty implants. Serum concentrations of LH and FSH, uterine weight, endometrial proliferation, and luteal tissue were assessed after 3 weeks of treatment. Based upon these parameters, we determined that effective doses were 5.0 mg NE, 7.5 mg NG, and 0.5 mg EE given as single implants and 10.0 mg MP given in two 5.0-mg implants. This is the first dosing study of contraceptive steroids in a murine model of lupus. Effective, nontoxic doses of these drugs can now be employed in studies of interactions between gonadal hormones and autoimmunity.

Long acting contraceptives. Present status

Long acting injectable hormonal contraceptives are among the most effective fertility regulating agents developed; yet they are also among the most controversial because of animal data indicating a possible carcinogenic potential in several species. A critical analysis of these animal findings has revealed, in all instances, the existence of specific mechanisms not occurring in the human. For this reason, most national and international scientific bodies who have reviewed this issue have concluded that there are no toxicological reasons for not using long acting hormonal contraceptives. Long acting agents can be divided into 2 separate groups: those having a duration of action of one month, which are composed of a long acting oestrogen and a progestagen, and those lasting for several months which consist of only a progestagen. Among the injectable progestagen-only contraceptives tested, only 2 have so far reached the international market: depot medroxyprogesterone acetate (DMPA), which has been administered at 3- or 6-month intervals and norethisterone enanthate, which has been injected at intervals ranging between 2 and 3 months. The most important side effect observed with these 2 agents is a complete disruption of the menstrual bleeding pattern, leading - in some cases - to total amenorrhoea, which is more frequent with depot medroxyprogesterone acetate than with norethisterone enanthate. The latter, however, has a shorter duration of action with a higher pregnancy rate than the former. Other adverse reactions are rare and of no real importance. Metabolic effects with progestagen-only injectable preparations are, in general, mild and less marked than with combined oestrogen-progestagen formulations. Recent investigations have shown that the return of fertility following their use is delayed but in no way impaired. Monthly injectable oestrogen-progestagen combinations have been tested to a more limited extent and these agents are available only in a very few countries. Their main advantage over progestagen-only preparations is that they allow a reasonable menstrual bleeding pattern in the majority of cases. Their obvious disadvantage is that they contain a long acting oestrogen.

Ovarian morphology during and after lynestrenol treatment around menopause

In this histological study, the inhibition of continuous oral administration of lynestrenol 5 mg/day on the ovarian follicle and corpus luteum development was found to be extremely pronounced. Known estrogen - producing structures such as antral, mature follicles and corpora lutea were completely absent during treatment. Structures devoid of cystic function however, as persistent and cystic follicles and follicular cysts, seemed not to be influenced in their histological appearance and frequency. As the recovery of the cyclic ovarian function after cessation of the medication compares favorably with the spontaneous cycle, a continuous lynestrenol treatment of 5 mg/day can be regarded as a safe endocrinological regimen.

Pathologic effects of oral contraceptives

The pathologic effects of oral contraceptives have been described in this paper and in other reviews [1, 5, 23, 35, 44, 48, 59, 80, 103, 114]. Approximately 10 million women currently use oral contraceptives in the United States. These drugs are beneficial both to the users and for population control. It is their effect on the health status of women who take them that must continue to have well-organized investigation so that more meaningful conclusions concerning their safety will permit continued use. In some instances, the pathologic effects of oral contraceptives make it necessary that new methods of contraception be found. Intensive research in this area is needed and judiciuos use of oral contraceptives must be maintained. A national registry should be formed to record and investigate the cases of women who die or have adverse reactions while taking these agents. A registry might identify associations no previously known to exist in patients taking oral contraceptives. It would serve to concentrate the data in one area so that more material would be available for the study of pathogenetic mechanisms. It would heighten patient and physician awareness of the untoward effects and increase the responsibilities of the women who take them to monitor their own health.

Hormonal correlates of normal and abnormal follicle growth after puberty in humans and other primates

After the menarche, changing levels of gonadotrophins, prolactin and sex steroid hormones in peripheral blood are accompanied by ovulation and corpus luteum formation in one follicle, and atresia in the remaining follicles maturing during each menstrual cycle. Available evidence suggests that blood levels of steroid hormones reflect in large part the secretory activity of the ovary containing a pre-ovulatory follicle and most probably of that follicle itself (see Chapter 6). These steroid secretions and those of the corpus luteum coordinate hypothalamic-pituitary-ovarian function. Within the ovary, sex steroid hormones mediate effects of gonadotrophins and prolactin on follicle maturation and participate in determining the fate of individual follicles.

Binovular follicles in the adult human ovary

The human ovary may contain binovular or polyovular follicles at birth, but they are unusual later in life. Binbovular follicles were found in bilateral ovarian biopsies from a patient with primary amenorrhea who had been treated with exogenous gonadotropins. The fine structural morphology of these follicles has shown that both oocytes were in the resting meiotic prophase, that their respective vitelline bodies faced each other across the intervening plasma membranes, and that the adjacent oocytes made mutual contacts similar to those found between granulosa cells and oocytes. From the appearance of the multivesicular bodies in nearby stromal fibroblasts it is suggested that these follicles had formed by fusion of two adjacent primordial follicles by a mechanism similar to the depolymerization of the ground substance in the apex of the Graafian follicle that leads to ovulation.