Erythema nodosum and oral contraceptive therapy

A generalized erythema nodosum developed in a 17 year old girl receiving oral contraceptive therapy, which was immediately discontinued. The erythema failed to respond to tetracycline, potassium iodide or prednisone therapy (partially successful), and recurred 6 times, usually just before menstruation. The recommended therapy is bed rest, salicylates and 10 cm roller elastic bandages. No medication can help in the face of unrestricted physical activity.     

Liver cell adenoma associated with oral contraceptive hormone therapy.

A patient receiving oral contraceptive hormone therapy developed a hepatic adenoma. Widespread haemorrhages, which were apparently unrelated to trauma, developed in the adenoma. Attention is drawn to the increasing incidence of Pill-associated hepatic tumours, and to the possibility of a fatal haemorrhage.     

Sequential oral contraceptive and breakthrough bleeding

A request for suggestions in management of a 38-year-old woman in good health suffering breakthrough bleeding after 3 years of therapy on ethinyl estradiol plus dimethisterone with ethinyl estradiol (Oracon) for the control of heavy menstrual flow elicited the following response. An extra tablet given on each day of spotting, a double dose for 3 days following bleeding, and an every-other-day double dose are all suggested methods for handling bleeding from oral contraceptives. With a single course of oral diethylstilbestrol 3 mg daily for 25 days combined with a progestational agent on Days 18-25 of each cycle, a return to normal menstrual function can be anticipated in most patients in the absence of some underlying disorder. It is suggested that provoked withdrawal bleeding can mask underlying dysfunction and that this possibility should be eliminated. Long-term steroid administration may incite physiological disturbances.     

Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.     

Benign breast disease and oral contraceptive use

A random selection of 1,230 upstate New York childbearing women was used to examine the history of oral contraceptive use in women with a clinical diagnosis of benign breast disease. We found that 73 women who had benign breast disease had a reduced duration of pill use. When determining the reason for this reduction, we found that in a significant portion (P less than .05) of our benign breast disease cases, the women had been advised by their physicians to discontinue pill use for breast-related reasons. We then surveyed a large group of upstate New York physicians. One third of them considered benign breast disease a potential contraindication for starting oral contraceptive use. Nearly one half throught the development of benign breast disease to be a potential contraindication for continuing oral contraceptive use. It is premature to conclude that oral contraceptive usage protects against benign breast disease.     

The relationship of tubal infertility to barrier method and oral contraceptive use

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.     

Hepatocelluilar carcinoma: a possible complication of oral contraceptive steroids.

A patient was found to have developed a primary hepatocellular carcinoma after taking an oral contraceptive steroid preparation for four years. After resection of the tumour over five years ago, and resumption of the birth control Pill, a recurrent hepatocellular caricnoma has developed. The risk of this complicationis extremely small and appears to be related to the duration of ingestion of the drug and to the amount of oestrogen present in the preparation used. The modes of presentation of these tumours and the methods of investigation are outlined, and the high incidence of spontaneous rupture causing life-threatening intraperitoneal haemorrhage is emphasized.