Activation of cardiac renin-angiotensin system and plasminogen activator inhibitor-1 gene expressions in oral contraceptive-induced cardiometabolic disorder

CONTEXT

Clinical studies have shown that combined oral contraceptive (COC) use is associated with cardiometabolic disturbances. Elevated renin-angiotensin system (RAS) and plasminogen activator inhibitor-1 (PAI-1) have also been implicated in the development of cardiometabolic events.

OBJECTIVE

To determine the effect of COC treatment on cardiac RAS and PAI-1 gene expressions, and whether the effect is circulating aldosterone or corticosterone dependent.

METHODS

Female rats were treated (p.o.) with olive oil (vehicle) or COC (1.0 µg ethinylestradiol and 10.0 µg norgestrel) daily for six weeks.

RESULTS

COC treatment led to increases in blood pressure, HOMA-IR, Ace1 mRNA, Atr1 mRNA, Pai1 mRNA, cardiac PAI-1, plasma PAI-1, C-reactive protein, uric acid, insulin and corticosterone. COC treatment also led to dyslipidemia, decreased glucose tolerance and plasma 17β-estradiol.

CONCLUSION

These results demonstrates that hypertension and insulin resistance induced by COC is associated with increased cardiac RAS and PAI-1 gene expression, which is likely to be through corticosterone-dependent but not aldosterone-dependent mechanism.

Concomitant Administration of Lumiracoxib and a Triphasic Oral Contraceptive Does Not Affect Contraceptive Activity or Pharmacokinetic Profile

This study evaluated the effect of lumiracoxib on the pharmacokinetics and pharmacodynamics of ethinyl estradiol (EE) and levonorgestrel (LN) in Triphasil-28 (a triphasic oral contraceptive). Females stabilized on Triphasil-28 continued on Triphasil-28 alone for another month (Treatment Period 1), then also received lumiracoxib (400 mg daily) or placebo for 28 days each (Periods 2 and 3) in a double-blind crossover design. Plasma pharmacokinetic profiles were assessed on Day 21 of Periods 2 and 3. Progesterone and plasma sex hormone binding globulin (SHBG) concentrations were measured before and 2 hours after Triphasil-28 administration on Day 21 of all three treatment periods. Lumiracoxib had no significant effect on EE or LN pharmacokinetics or on progesterone or SHBG concentrations, indicating that anovulation and Triphasil-28 effectiveness was maintained. Adverse events were similar for lumiracoxib and placebo. Therefore, no clinically important consequences are anticipated if lumiracoxib is coadministered with oral contraceptives containing EE or LN.

Effects of chronic treatment with cyclooxygenase inhibitor, indomethacin on oral contraceptive-induced high blood pressure in female rats

The present study sought to investigate the effects of prostaglandins synthesis inhibition with indomethacin on blood pressure, heart rate, cardiac weight, plasma electrolytes and cardiovascular responses to arterial baroreceptor stimulation in Oral contraceptive (OC) treated female Sprague-Dawley rats. Oral administration of synthetic oestrogen, ethinyl oestradiol in combination with progestogen, norgestrel for ten weeks significantly increased blood pressure and cardiac weight compared with those of the control rats. Concomitant treatment with indomethacin significantly abrogated increase in blood pressure but did not affect the increase in cardiac weight induced by OC. Heart rate, plasma sodium and potassium concentrations were not affected by OC and/or indomethacin treatment. OC treatment did not alter sympathetic-mediated pressor and tachycardiac responses caused by bilateral carotid baroreceptors unloading. However, these responses were significantly attenuated by indomethacin treatment. These results demonstrated that rat model of OC-induced high blood pressure developed cardiac hypertrophy that is not associated with altered sympathetic-mediated cardiovascular responses to arterial baroreceptor stimulation. The finding that indomethacin prevented OC-induced high blood pressure, but not associated cardiac hypertrophy implies that synthesis of prostaglandins may be an important determinant of OC-induced hypertension, while associated cardiac hypertrophy may not be pressure overload-dependent.

A clinical study of transdermal contraceptive patch in Thai adolescence women

OBJECTIVE

To study cycle control, compliance and safety of a transdermal contraceptive patch in adolescent Thai women.

MATERIAL AND METHOD

Fifty-eight healthy women were assigned to receive 3 cycles of contraceptive patch (ethinyl estradiol 20 microg and norelgestromin 150 microg/day). All participants aged 16-20 years were invited to participate from the family planning clinic at King Chulalongkorn Memorial Hospital. Data were collected on adverse effects, perceived advantages and disadvantages, body weight, blood pressure, patch detachments and compliance. Data were analyzed using mean, percentage and student's t-test.

RESULTS

The participants' average age was 19.4 years, height 158.8 cm, weight 51.8 kg, BMI 20.8 Kg/m2. The most location of patch application was the abdomen and the most adverse event was breast tenderness (31.0%) followed by application site reaction, nausea vomiting and headache respectively. The breast symptom was mild in severity. The participants reported decrease in dysmenorrhea and shorter duration of bleeding. There were no significant changes in body weight and blood pressure. The improvement of their facial acne was reported. There were no pregnancies during use and the adhesion of the contraceptive patch is excellent. Partial patch detachment was reported in only 6.9%. No completed patch detachment was found.

CONCLUSION

The present study found an overall positive impression of a new transdermal contraceptive patch. The good compliance and few side effects were demonstrated. The adhesive patch contraceptive was excellent.

Different effects of oral contraceptives containing different progestogens on protein S and tissue factor pathway inhibitor

BACKGROUND

Oral contraceptives (OC) containing different types of progestogens induce different sensitivities to activated protein C (APC) measured with the thrombin generation-based APC-resistance test. These differences in APC resistance may be the biological explanation for the differences in thrombotic risk of the various pills. The mechanistic basis of APC resistance observed in OC users is unknown. Our objective was to study the effect of OC on the two main determinants of the APC-resistance test, free protein S and free tissue factor pathway inhibitor (TFPI).

PATIENTS/METHODS

We measured free protein S and free TFPI in 156 users of various types of OC.

RESULTS

Users of desogestrel-containing OC, known to double the risk of thrombosis compared with levonorgestrel-containing OC, had lower free protein S (24 vs. 33 U dL(-1)) and TFPI free antigen (2.9 vs. 3.6 ng mL(-1)) levels than users of OC containing levonorgestrel. Women using cyproterone acetate-containing OC, known to confer a high thrombotic risk, had the lowest free protein S (19 U dL(-1)) and free TPFI antigen (2.5 ng mL(-1)) levels. Users of OC containing drospirenone had lower free protein S (23 U dL(-1)) and TFPI antigen levels (3.2 ng mL(-1)) than users of levonorgestrel-containing OC. Low free protein S and low free TFPI antigen levels were associated with an increased resistance to APC, an established risk factor for thrombosis.

CONCLUSIONS

This study observed that the differences in APC resistance induced by OC containing different progestogens can at least in part be explained by different effects of OC on free protein S and TFPI.

Contraceptive, cerebral vein thrombosis and choked discs

PURPOSE

To raise awareness of the importance of prompt and appropriate imaging in patients presenting with signs and symptoms suggestive of idiopathic intracranial hypertension.

METHODS

Case report with diagnostic tests and discussion of management options.

RESULTS

A 15-year-old girl presenting with bilateral optic disc swelling was noted to have extensive thrombosis of intracerebral venous sinuses with the clot extending along the internal jugular vein as inferior as the root of the neck demonstrable on magnetic resonance venography.

CONCLUSIONS

Ophthalmologists should be vigilant in obtaining appropriate imaging in cases of optic disc swelling.

[Hormonal contraception and cervix of the uterus pathology]

The effect of hormonal contraception on cervix of the uterus of young nullipara women with ectopia was investigated. Cohort study was carried out by using simple blind method. By means of statistical data manipulation correlation between the application of hormonal contraceptives and changes of colposcopy pictures in the zone of pathology was displayed. Excluton showed low percent anomalous colpscopy picture in pathology zone. Excluton was declared as medicine of choice for nullipara women with ectopia. Still it is necessary to conduct a strong dynamic control of cervix of the uterus (colposcopy and pap-smear test) in order to avoid complications.

[Ectopia of cervix of the uterus and hormonal contraception]

The aim of the study was the investigation of impact of different hormonal contraceptive drugs on cervix of uterus of young nullipara women with ectopia. Cytologic smears were examined using Pappanikolau method. Cohort study was carried out by using simple blind method. The data were treated by statistics packet (SPSS). The results displayed correlation between taking the hormonal contraceptives Rigevidon and Marvelon and in transformation of ectopia into micro glandular hyperplasia, which did not occur in taking medicine Exluton. Drug Exluton is recommended for young nullipara women with ectopia to exclude micro glandular hyperplasia. In case of prescribing monophase contraceptives for young nullipara women with ectopia cytological control of endo- and exo-cervix is recommended.

Long-term safety of an extended-cycle oral contraceptive (Seasonale): a 2-year multicenter open-label extension trial

OBJECTIVE

The purpose of this study was to assess the long-term safety of Seasonale, 91-day extended-cycle oral contraceptive (OC).

STUDY DESIGN

Following completion of a 1-year Phase 3 multicenter trial, patients from selected centers were invited to participate in this 2-year extension trial. In this open-label study all participants received the 91-day extended-regimen OC, Seasonale.

RESULTS

There were 189 study participants enrolled from 27 sites. Patient exposure included 1130 completed 91-day cycles. Overall rates of study discontinuation and the incidence of adverse events were similar to the earlier Phase 3 clinical trial. Seasonale was well tolerated and the number of reported bleeding and/or spotting days reported diminished during the course of the study.

CONCLUSION

This study confirms the findings from the previous clinical trial and demonstrates that Seasonale is a safe and effective therapy for long-term use.

Contraceptive-Related Cerebral Venous Thrombosis With Profuse Vaginal Bleed

INTRODUCTION

Women on hormonal therapy for menorrhagia are at risk for cerebral venous thrombosis.

CASE REPORT

This scenario may become complicated when there is profuse vaginal bleed with the withdrawal of hormonal therapy. There are no reports describing the possible therapeutic approaches in this clinical situation.

RESULTS

A 42-year-old female with a history of uterine fibroids and menorrhagia taking an estrogen-progesterone combination pill presented with seizure clusters. Neuro-imaging showed lateral sinus thrombosis and biparietal hemorrhagic infarcts. Withdrawal of the contraceptive pill was associated with profuse vaginal bleed, leading to hemodynamic instability and the need for multiple blood transfusions. As an emergent procedure to stop the vaginal bleeding, the patient was implanted with a levonorgestrel intrauterine system; with this, vaginal bleed stopped within 12 hours with hemodynamic stability. Subsequently, the patient was treated with unfractionated heparin followed by warfarin (target international normalized ratio: 2.5-3). She made a good neurological recovery.

CONCLUSION

This case illustrates that LNG-IUS can be an innovative choice for local hormonal therapy in a patient with OCP-related cerebral venous thrombosis and simultaneous vaginal bleeding.

Peliosis hepatis revealed by biliary colic in a patient with oral contraceptive use

Peliosis hepatis is a rare condition associated with a variety of diseases and drugs. We report a patient who developed peliosis hepatis while taking oral contraceptives. Three months after withdrawal of this oral contraceptive, reduction in size of these lesions was observed.

[Occurrence of bleeding in women using combined hormonal contraceptives (ethinylestradiol 35 micrograms/norgestimate 250 micrograms in relation to regularity of administration and cycle start day]

OBJECTIVE

To assess the frequency of irregular intermenstrual bleeding in combined oral contraceptive (ethinylestradiol 35 micrograms/norgestimate 250 micrograms, COC) users and the influence of regularity of pill use on this frequency; to assess the occurrence of withdrawal bleeding during weekends in women using the COC from the first Sunday in the cycle (Sunday start method).

DESIGN

Prospective, open, non-comparative, multicenter study in 27 centers.

METHODS

The first day of the pill use, occurrence of intermenstrual and withdrawal bleeding and regularity of use were assessed by means of patient's bleeding diary. Body weight, blood pressure and side effects were monitored before the oral contraceptive use and after the third cycle.

RESULTS

358 (94%) of 382 women completed the study. Frequency of intermenstrual bleeding was generally low (6.7%, 5.0% and 5.0% in the first, second and third cycle) and highly influenced by regularity of pill use (2.6%, 0% a 1% in regular users versus 30.2%, 32.1% a 24.2% in irregular users). 28%, 40% and 47% of Sunday start users achieved bleeding-free weekends after the first, second and third cycle. Body weight and blood pressure did not change during the study.

CONCLUSION

Frequency of intermenstrual (breakthrough) bleeding during the first three months of COC use is highly influenced by regularity of use. In regular users of monophasic COC containing ethinylestradiol 35 micrograms/norgestimate 250 micrograms the frequency of intermenstrual bleeding is bellow 2.6%. In Sunday start users the proportion of women with bleeding-free weekends (i.e. weekends without the occurrence of withdrawal bleeding) increases to 47% after the third cycle.

Oral contraceptive-induced central retinal artery occlusion

Oral contraceptives are known to have ocular complications including retinal vascular lesions. The authors report a case of central retinal artery occlusion in a young woman on oral contraceptives.

Biphasic versus triphasic oral contraceptives for contraception

Side effects caused by oral contraceptives discourage compliance with and continuation of oral contraceptives. A suggested disadvantage of biphasic oral contraceptive pills compared to triphasic oral contraceptive pills is an increase in breakthrough bleeding. We examined this potential disadvantage by conducting a systematic review comparing biphasic oral contraceptives with triphasic oral contraceptives in terms of efficacy, cycle control, and discontinuation because of side effects. We included randomized, controlled trials comparing any biphasic oral contraceptive with any triphasic oral contraceptive when used to prevent pregnancy. Only two trials of limited quality met our inclusion criteria. Larranaga compared two biphasic and one triphasic pills, each containing levonorgestrel and ethinyl estradiol. No important differences emerged, and the frequency of discontinuation because of medical problems was similar with all three pills. Percival-Smith compared a biphasic pill containing norethindrone (Ortho 10/11) with a triphasic pill containing levonorgestrel (Triphasil) and another triphasic pill containing norethindrone (Ortho 7/7/7). The biphasic pill had inferior cycle control compared with the levonorgestrel triphasic pill. The available evidence is limited and of poor quality; the internal validity of these trials is questionable. Given that caveat, the biphasic pill containing norethindrone was associated with inferior cycle control compared with the triphasic pill containing levonorgestrel. This suggests that the choice of progestin may be more important that the phasic regimen in determining bleeding patterns.

Renal papillary necrosis as first presentation of a Nigerian sickle cell patient

The clinical features of the sickle syndromes do not appear until after the sixth month of life, at which time most of the HbF has been replaced by HbS. Thrombo-embolic complications, retinopathy and renal papillary necrosis are more frequent in HbSC disease than in other sickle cell syndromes. First presentation of HbSC disease after the second decade is considered late in this environment. A 25 year-old Nigerian female patient is hereby presented with renal papillary necrosis as first presentation of HbSC disease. The patient presented with a sudden onset of total haematuria without history suggestive of urinary tract infection, trauma, instrumentation and significant analgesic consumption. No history of usage of herbal remedies, diabetes mellitus, sore throat, abdominal pains, skin rashes or joint pains. Physical examination did not show any characteristic habitus or findings. Findings on intravenous urography suggested renal papillary necrosis.

A comparative and pooled analysis of the safety and tolerability of the contraceptive patch (Ortho Evra/Evra)

OBJECTIVE

To review the safety and tolerability of the contraceptive patch (Ortho Evra/Evra) versus a standard oral contraceptive (Triphasil) and to present the pooled safety and tolerability of the patch across three pivotal studies.

DESIGN

Three open-label, contraceptive studies of up to 13 treatment cycles.

SETTING

183 centers.

PATIENT(S)

Comparative study (812 patch, 605 oral contraceptive); pooled analysis (3,330 patch).

INTERVENTION(S)

The patch regimen was three consecutive 7-day patches (21 days) followed by 1 patch-free week per cycle; the oral contraceptive was dosed according to the U.S. physician package insert.

MAIN OUTCOME MEASURE(S)

Adverse events, laboratory tests, vital signs, and body weight.

RESULT(S)

The incidence of most events was similar between the patch and oral contraceptive groups, with the exception of a higher incidence of application site reactions, breast discomfort (cycles 1 and 2 only), and dysmenorrhea in the patch group. Pooled analysis demonstrated that most application site reactions (92%) and breast symptoms (86%) were mild or moderate in severity, and <2% of participants discontinued the patch because of either event. Only 7 (0.2%) participants experienced a serious adverse event classified as possibly, probably, or likely related to the patch. The mean change in body weight from baseline to the end of treatment was an increase of 0.3 kg.

CONCLUSION(S)

Overall, the contraceptive patch is well tolerated and has a side effect profile similar to an established oral contraceptive.

Acne resolution rates: results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara) and EE/LNG (Microgynon)

BACKGROUND AND OBJECTIVE

Acne in women can often be successfully treated by the intake of oral contraceptives containing gestagens with anti-androgenic properties. This study aimed to evaluate the efficacy of the monophasic oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA; Belara for the treatment of mild to moderate papulopustular acne of the face and acne-related disorders in comparison to EE/levonorgestrel (LNG; Microgynon.

METHODS

199 female acne patients were enrolled in a single-blind, randomized, multicentre phase III study and divided into two groups who received either EE/CMA or EE/LNG. The primary end point was fulfilled if the number of papules/pustules per half of the face present on admission had decreased by at least 50% in the 12th medication cycle.

RESULTS

59.4% of the women under EE/CMA and 45.9% under EE/LNG were responders. The relative frequency of women with complete resolution was 16.5% under EE/CMA and 4.3% under EE/LNG at cycle 12.

CONCLUSION

EE/CMA is an efficient treatment for women with mild and moderate papulopustular acne of the face and related disorders, reflecting the well-known anti-androgenic properties of the progestogen CMA.

Rapid improvement of icterus and pruritus by the oral administration of colestimide in two cases of drug-induced hepatitis

We report two cases of drug-induced hepatitis refractory to therapy of ursodeoxycholic acid and prednisolone, who were relieved of icterus and pruritus immediately by the oral administration of colestimide. Their liver dysfunction was not improved, by withdrawal of causative drugs or by treatment with prednisolone and ursodeoxycholic acid. Colestimide (3.0 g/day), a strong basic anion-exchange resin, was orally taken before breakfast and evening meal, leading to rapid and complete relief of icterus and pruritus. These cases suggested that colestimide would be useful for patients with cholestasis in drug-induced hepatitis, because this agent has few side effects and it is easy to take.

Impact of oral contraceptive use on APC-resistance: a prospective, randomized clinical trial with three low-dose preparations

The evaluation of the study was of the impact of oral contraceptive (OC) use on activated protein C (APC-resistance). Eight hundred eighteen young fertile women were screened for a study designed to compare three different marketed OC preparations. The women could have used either other oral contraceptive preparations before switching to the study medications (switchers) or were not using hormonal contraceptives (new starters) before the study began. Prior to study drug intake and during treatment, APC-resistance was determined with three different tests. Forty-one of 809 women evaluated (5.07%) carried the Factor V Leiden mutation. Twenty-two further participants (2.72%) had a positive screening test, but did not provide samples for the confirmatory mutation test. Two women with homozygous Factor V Leiden mutations and 39 women with heterozygous mutations were identified. The homozygous carriers were identified in all three of the screening tests employed, whereas none of the tests detected all 39 heterozygotes. In the pretreatment screening tests, previous OC users (switchers) had slightly lower APC ratios than the women using non-hormonal birth control methods (starters). During treatment the difference between starters and switchers was no longer apparent, but the APC ratio values of the screening tests slightly increased for both. The homozygous carriers were not treated. Differences in APC-resistance between users of the three different oral contraceptive preparations were not found. In conclusion, laboratory screening for APC-resistance using Coatest APC, ProC Global, or ProC APC-FV-Leiden clearly identifies homozygous mutant carriers. However, with regard to heterozygous mutant carriers, the sensitivity and specificity of the tests, especially during OC intake, is limited. The results of APC screening tests should have, at present, no impact on contraceptive counseling because the predictive value for thromboembolic risk of the test results and even the mutant status is low.

Rapid disappearance of hepatic adenoma after contraceptive withdrawal

We present the case of a 25-year-old woman who developed a large central liver adenoma after 8 years of continuous oral contraceptive use. The first diagnosis was made by ultrasonography, after a rise in plasmatic gamma-glutamyl-transpeptidase and alkaline phosphatase levels was noted. Withdrawal of the oral contraceptive was followed by shrinkage of the adenoma, with complete disappearance 9 months after the diagnosis. Hepatic adenoma (HA) still presents problems in terms of differential diagnosis and clinical management. There are reports of complete or partial regression of an HA after discontinuation of oral contraceptives, but they are poorly documented. To our knowledge, a patient with such rapid disappearance of a large HA has never been reported.

Testing the tyrosine/catecholamine hypothesis of oral contraceptive-induced psychological side-effects: a controlled study on triphasil

BACKGROUND

This study was conducted to probe the existence of oral contraceptive (OC)-induced psychological side effects that might be undetectable by psychometric testing.

METHODS

Triphasil was administered during six complete menstrual cycles to young never-OC-users. Plasma Tyr and Trp/Sigma-respective competitor neutral amino acids (NAA) ratio and concentrations of other amino acids (AA), known to be involved in the functioning of the central nervous system (CNS) and the synthesis of neurotransmitters, in particular, were used as biochemical markers to assess this likelihood. Factors known to influence plasma AA concentrations such as cortisol and pyridoxal phosphate (PLP, active form of vitamin B6), both modulators of AA intestinal absorption, were examined.

RESULTS

Dietary supply of amino acid substrates (precursors) and blood levels of coenzyme/cofactor (vitamin B6 and iron) involved were adequate in both groups and were kept constant throughout the treatment. The rise in plasma cortisol, known to be stimulated under the action of estrogen, was significant (p < 0.05) after the first menstrual cycle and remained higher (although not significantly) than mean baseline and reference normal values at the end of the 6-month OC treatment. Plasma Trp/Sigma-specific competitor NAA ratio remained unchanged whereas Tyr/Sigma-specific competitor NAA ratio was significantly (p < 0.02) reduced after the sixth artificial menstrual cycle.

CONCLUSION

Although plasma AA biochemical markers cannot accurately assess CNS activity, they seem to be more sensitive than a comprehensive psychometric testing (MMPI) in assessing OC-induced psychological changes.

Comparison of a novel norgestimate/ethinyl estradiol oral contraceptive (Ortho Tri-Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20

This multicenter study compared the contraceptive efficacy, cycle control, and safety of a new triphasic norgestimate (180/215/250 microg)/ethinyl estradiol 25 microg regimen (Ortho Tri-Cyclen Lo) (n = 1,723) with that of norethindrone acetate 1 mg/ethinyl estradiol 20 microg (Loestrin Fe 1/20) (n = 1,171). Healthy women were treated for up to 13 cycles. Demographics were similar between regimens. Contraceptive efficacy was comparable for Ortho Tri-Cyclen Lo and Loestrin Fe 1/20. The overall and method failure probabilities of pregnancy through 13 cycles were 1.9% and 1.5%, respectively, with Ortho Tri-Cyclen Lo and 2.6% and 2.4%, respectively, with Loestrin Fe 1/20. Breakthrough bleeding and spotting was reported by a significantly lower percentage of participants in the Ortho Tri-Cyclen Lo group compared with the Loestrin Fe 1/20 group. At representative Cycles 1, 3, 6, 9, and 13, breakthrough bleeding and spotting rates were 16.3, 11.5, 10.3, 7.9, and 7.7%, respectively, in the Ortho Tri-Cyclen Lo group and 34.9, 22.9, 22.2, 15.9, and 13.1%, respectively, in the Loestrin Fe 1/20 group. Compliance and safety data were similar for the two regimens.

Knowledge of emergency contraception among pharmacists and doctors in Durban, South Africa

OBJECTIVE

To determine the level of knowledge of emergency contraception among private-sector pharmacists and doctors.

METHOD

This hand-delivered, confidential questionnaire survey was undertaken in North and South Central Durban, Kwazulu-Natal, South Africa. The main outcome measures were frequency of demand for emergency contraception and knowledge of its dosing schedule, side-effects and contraindications.

RESULTS

Ninety-six per cent of pharmacists and 93% of doctors had received requests for emergency contraceptive pills within the past year. Thirty-two per cent of pharmacists and 28% of doctors prescribed the Yuzpe regimen correctly. Only 23 (27%) doctors and 25 (22%) pharmacists were able to identify three common side-effects associated with emergency contraceptive pills. Forty-six per cent of pharmacists and 49% of doctors correctly indicated that there are no absolute contraindications to emergency contraceptive pills other than a contraindication to contraceptive pills. Fifty-four per cent of pharmacists and 35% of doctors agreed that the multiple use of emergency contraceptive pills is risky.

CONCLUSION

There is an urgent need to improve the knowledge of health-care workers regarding emergency contraception, which forms an important back-up method when existing contraception fails or is not used.

Ectopic gestation following emergency contraceptive pill administration

Emergency contraceptive pill prescription following rape is common. We report a case of ectopic gestation after emergency contraceptive pill failure and review the literature on this rare complication. A 26-year-old woman with a normal menstrual period 2 weeks before was administered an emergency contraceptive pill 8 hours after a single sexual assault. The assault was her only sexual activity before and after the emergency contraceptive pill use. Forty-six days following the assault, the patient presented with a right ampullary tubal pregnancy of 59 days gestation and underwent emergent surgery for ectopic gestation. To prevent a delay in the diagnosis of ectopic pregnancy, we recommend that providers and the package insert advise women, that ectopic gestation can occur with emergency contraceptive pill failure.

[The use of the preparation Anteovin in dysfunctional uterine hemorrhages and PCOS]

The present prospective study is aimed at estimating the therapeutic effect of a biphasic oestrogen dominated contraceptive pill Anteovin in certain forms of dysfunctional uterine bleeding (DUB) and in polycystic ovary syndrome (PCOS) which is associated with dysfunctional bleeding. Two groups of women were studied--the first group (n = 34) consisted of women with DUB; the second group (n = 31) comprised PCOS. The nature and dynamics of uterine bleeding, contraceptive effectiveness and occurrence of side effects were followed up. In the second group the changes in the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and prolactin (Prl) were additionally investigated.

RESULTS

A significant decrease in bleeding was observed in both groups. In the second group it is in parallel with a significant decrease of T even as early as on the third month and of DHEA-S on the sixth month of treatment. No significant changes in prolactin levels were found out during the treatment.

CONCLUSION

The biphasic contraceptive pill Anteovin has a very good therapeutic effect in DUB and metrorrhagic forms of PCOS while at the same time the side effects are slightly expressed and transitory and an excellent contraception is achieved.

[Our 3- to 5-year experience with Anteovin]

Anteovin was used in the treatment of dysmenorrhoea, climax precox, dysfunctional uterine bleeding, bleeding with IUD and oral contraceptive. 247 women and adolescents for 6761 cycles were treated with Anteovin for period of 3-5 years. Results were excellent. 21 women--8.17% had side effects.

[Changes in the concentration of individual proteins in women using current peroral contraceptives]

BUT: The aim of the present study was to establish the influence of the moderate combined oral contraceptives on the concentration of the individual proteins in serum.

MATERIAL AND METHODS

The study included 70 women at the age from 16 to 30, separated into two groups: control group, including 30 women who have not used OC basic group, including 40 women using Cilest and Marvelon in the period of one to three years. There have been examined the following individual proteins in serum: prealbumin; orosomucoid; haptoglobin; TRA; C3; C4; CRP; IgA; IgG and IgM. Their level in serum was defined with immunoturbidimetric method with monoclonal antibodies of the firm Kone (Fin).

RESULTS

The data showed reduced concentrations of Orosomucoid and increased concentrations of TRA in the basic group.

CONCLUSIONS

The continuous use of Cilest and Marvelon do not influence the concentrations of the examined individual proteins in the serum. They lead to reduced concentrations of orosomucoid and increased concentrations of TRA.

Oral contraceptives: a cause of hyperbilirubinemia in stem cell transplant patients

Conjugated hyperbilirubinemia in the clinical setting of hematopoietic stem cell transplantation can have multiple etiologies that may prompt various therapeutic interventions. Two patients who received short courses of a high-dose estrogen-progesterone combination to treat breakthrough menstrual bleeding during transplant are reported. Conjugated hyperbilirubinemia developed in both patients within days of beginning therapy and resolved after the ethinyl estradiol and norgestrel (Ovral; Pharmacia and Upjohn, Kalamazoo, MI, U.S.A.) was discontinued. In one of the patients, this occurred on three separate occasions during the course of transplantation. Recognizing the cholestatic effect of estrogens during transplantation may prevent unnecessary alterations in therapy beyond the simple discontinuation of these medications.

Ischemic colitis and acquired resistance to activated protein C in a woman using oral contraceptives

We present the case history of a 22-yr-old woman diagnosed with ischemic colitis associated with the use of oral contraceptives (OC). At the time of her presenting symptoms activated protein C (APC) resistance, a risk factor for thrombosis, was demonstrated. There was no laboratory evidence of inherited thrombophilia; that is, antithrombin III, protein C and protein S levels were normal and the factor V Leiden mutation was not present. The OC were discontinued and the patient's symptoms improved. Subsequent evaluation revealed that the activated protein C resistance had resolved. This case illustrates APC resistance as a potential link between OC use and its known association with ischemic colitis.

Nutritional and psychological status of young women after a short-term use of a triphasic contraceptive steroid preparation

The present study was aimed to assess the psychological status of young healthy women after the administration of a triphasic contraceptive steroid preparation for six complete menstrual cycles. Subjects had never used oral contraceptives (OC) and had neither a familial history of depression nor psychological disturbances. OC-induced psychological disturbances were interpreted for years as evidence of pyridoxine (vitamin B6) deficiency. Other nutritional deficiencies, namely in cobalamin, folate and iron, can disturb the functioning of the central nervous system. In addition, a deficiency of any of these nutrients can lead to several anemia-induced symptoms that are highly susceptible to influence the psychological status. For ample evidence, nutritional status was then evaluated in parallel to psychological testing. Blood iron and vitamin levels of interest were found to be adequate and could not have biased the response to a psychological test (MMPI). This study showed that a 6-month Triphasil treatment did not modify significantly the psychological status of subjects. To our knowledge, this is the first psychological study on young never OC-users taking an identical triphasic contraceptive steroid preparation to investigate early psychological side-effects due to OC, at a similar time of the menstrual cycle, when nutritional status was also evaluated.

[The use and effects of postcoital contraception]

OBJECTIVES

To find those people seeking post-coital contraception (PCC), its efficacy and effects.

DESIGN

A crossover study using a structured questionnaire, filled in both at the moment of demand and after using PCC.

SETTING

The "Nóvoa Santos" Family Planning Centre in Ourense.

PARTICIPANTS

All those requesting PCC between January 1995 and June 1996 (220 in all).

INTERVENTIONS

The PCC norm was 8 pills, two taken every 12 hours, of 0.05 mg of Ethinyloestradiol (EE) plus 0.5 mg of Norgestrel.

MEASURES AND MAIN RESULTS

We analysed social and demographic variables, sexual behaviour and PCC use with the SPSS programme for Windows. 96.4% attending were women, average age 21.98. They began coitus at 18.58 years old. 191 (86.8%) had a stable partner and 0 to 3 coitus per week. The condom was the commonest method (90.6%).

CONCLUSIONS

Young women requesting PCC immediately after the risk coitus are students and residents in the city. It is a method used when there are problems with the condom and the frequency of failure is low. Sexually active people should be informed of the existence and use of PCC, as should the health professionals who could be asked for it.

[The use of the preparation Cilest in the practice of the Bulgarian Association for Family Planning]

Data are presented from a questionnaire study on the sexual activity of Bulgarian teenagers as well information on the contraceptive methods chosen by them. The authors inform in short about the activities of the Bulgarian Association for Family Planning (BAFP). Analyses are made of the data obtained from BAFP card-index for the last two years. Information is given on the number of observed cycles, types of applied contraceptive method, aims of their application (contraception, treatment of acne, menstrual disturbances etc.). The attention was concentrated on the third generation contraceptive pills Cilest, on the age of patients, as well as on the adverse effects--change in blood pressure, body-weight changes, intermenstrual bleeding, hairiness, breast problems, paraclinical changes, etc. Underlined is the number of teenagers who seen the BAFP help on problems of contemporary contraception. The observed cycles show a very small percentage of adverse effects with hormonal contraception, mainly during the first 2 of 3 cycles, with predominance of intermenstrual bleeding. No body-weight changes or increased hairiness were observed.