The effect of low-dose oral contraceptives on cardiorespiratory function, coagulation, and lipids in exercising young women: a preliminary report

A study was undertaken to determine whether low-dose oral contraceptive usage would negate the beneficial effect of exercise on cardiorespiratory fitness, lipid and lipoprotein levels, and coagulation. Twelve exercising women were randomly allocated to groups of either oral contraceptive users or non-oral contraceptive users. When compared with results in the control group, maximal oxygen uptake (ml/kg1 X min1) decreased significantly in the oral contraceptive users during the 6-month period of observation. This was associated with an 8% decrease in both the oxygen uptake (2.34 to 2.17 L/min) and the oxygen pulse (12.1 +/- 3.2 to 11.2 +/- 2.2 ml/beat). The serum cholesterol, triglycerides, high-density lipoprotein/cholesterol, and high-density lipoprotein subfractions 2a and 2b levels were not altered. A significant increase in plasminogen activity was found in the oral contraceptive users: values increased from a coherent time average of 3.8 +/- 0.5 U/ml at baseline to 5.7 +/- 0.7 U/ml at 6 months; values returned to baseline levels 1 month after stopping the oral contraceptives (coherent time average of 3.9 +/- 0.6 U/ml; p less than 0.0001). No other significant changes were noted in the coagulation and anticoagulation factors studied. Low-dose oral contraceptive usage is associated with a decrease in functional aerobic capacity, but it does not impinge on the hemostatic mechanism or lipid-lipoprotein metabolism.     

Randomized control study of the effects of raloxifene on serum lipids and homocysteine in older women

OBJECTIVE(S): Raloxifene, a selective estrogen receptor modulator, has beneficial estrogen agonist effects on bone and cardiovascular risk factors and estrogen antagonist effects on the breast and uterus. Limited clinical data have shown a sustained decrease in total cholesterol, low-density lipoprotein cholesterol, and homocysteine levels; an elevated homocysteine level is an independent risk factor for atherosclerosis. All of these studies were conducted in relatively young populations of women (mean age, 52-54 years). Raloxifene does not affect hot flushes, a major immediate symptom of menopause. This drug may therefore be useful in older women to prevent osteoporosis and cardiovascular disease. The aim of this clinical study was to evaluate the effects of raloxifene on plasma lipids and homocysteine in older women. STUDY DESIGN: The subjects were 45 healthy postmenopausal women, aged 60 to 70 years. The women were randomly assigned to therapy with raloxifene or placebo, 60 mg/d for 1 year. Twenty-six women received raloxifene and 19 received placebo. Checkups were performed every 3 months. At baseline and after 3, 6, 9, and 12 months of treatment we measured homocysteine, total serum cholesterol, triglycerides, and both high-density lipoprotein and low-density lipoprotein cholesterol. RESULTS: An effect on lipids was evident by 3 months with no significant additional modification at 12 months. Mean low-density lipoprotein cholesterol levels were lowered by 15% and total cholesterol was lowered by 8.5%. No reduction in high-density lipoprotein cholesterol or triglycerides was observed. After 3 months of therapy, homocysteine was significantly lower than at baseline (9.9 +/- 1.6 vs 11 +/- 2.1 micromol/L; P < .05). The greatest reduction with respect to baseline was reached after 6 months of therapy (-19.5% +/- 3%; P < .05). CONCLUSION(S): The results of our study show that raloxifene at a dose of 60 mg/d reduces serum concentrations of low-density lipoprotein cholesterol and total cholesterol in healthy older women. Our study shows that in older women raloxifene leads to a 19.5% +/- 3% reduction in fasting homocysteine levels. Raloxifene may have a favorable effect on the incidence of cardiovascular disease in older women.     

Comparison of transdermal and oral estrogen-progestin replacement therapy: effects on serum lipids and lipoproteins.

OBJECTIVE: We attempted to ascertain whether transdermal postmenopausal estrogen-progestin therapy has the typical effects of oral therapy on serum lipoprotein risk markers for cardiovascular disease. STUDY DESIGN: Sixty-one postmenopausal women were randomized to receive either transdermal continuous 17 beta-estradiol, 0.05 mg/day, with transdermal cyclic norethindrone acetate, 0.25 mg/day, or oral continuous conjugated equine estrogens, 0.625 mg/day, with oral cyclic dl-norgestrel, 0.15 mg/day. Twenty-nine untreated subjects served as controls. Lipoprotein profiles at 3 and 6 months were compared with baseline values by means of analysis of variance. RESULTS: In the estrogen-alone phase both therapies reduced serum levels of total and low-density lipoprotein cholesterol; high-density lipoproteins were largely unchanged. Oral therapy increased triglycerides whereas this lipid fell with transdermal therapy. In the combined phase of the cycle both therapies reduced triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. CONCLUSION: Transdermal and oral therapies had similar effects on lipoprotein cholesterol but different effects on triglycerides.     

Correcting misconceptions about oral contraceptives

Although the majority of American women believe that oral contraceptives can cause serious health problems such as cancer or heart disease, the scientific literature does not support these beliefs. Oral contraceptives actually protect against endometrial and ovarian cancer. The increased incidence of cardiovascular disease in oral contraceptive users, including myocardial infarction, appears to be caused by thrombosis and not atherosclerosis. The studies suggesting an increased risk of cardiovascular disease in oral contraceptive users were published in the late 1970s and therefore used a data base of women ingesting formulations containing 50 micrograms of estrogen or more. More recently published data involving healthy women taking mainly lower estrogen dose preparations suggest that there is no increased incidence of myocardial infarction or stroke. Nearly all published studies indicate that there is no increased risk of myocardial infarction in former users of oral contraceptives. Animal data actually suggest that oral contraceptives may have a protective effect against atherosclerosis, even in the presence of lowered high-density lipoprotein levels. The low-dose triphasic and monophasic formulations are effective, safe methods of contraception that can be used by most healthy women of reproductive age.     

Treatment of hirsutism with ethinyl estradiol-desogestrel contraceptive pills has beneficial effects on the lipid profile and improves insulin sensitivity

OBJECTIVE: To evaluate the effects on the lipid pattern and insulin sensitivity of hirsute women of an oral contraceptive pill containing 30 microg of ethinyl estradiol and 150 microg of desogestrel. DESIGN: Prospective clinical study. SETTING: Tertiary care institutional hospital. PATIENT(S): 16 hirsute women. INTERVENTION(S): Women were evaluated at baseline and after receiving six cycles of oral contraceptive therapy. MAIN OUTCOME MEASURE(S): Body mass index (BMI); hirsutism score (nine body areas); serum levels of total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, lipoprotein(a), and serum adrenal and ovarian androgens; and fasting glucose and insulin concentrations. RESULT(S): The mean serum total, HDL, and LDL cholesterol levels increased after six cycles of oral contraceptive therapy. Levels of HDL cholesterol were < 50 mg/dL in 7 of the 16 patients at baseline; these levels normalized in 4 patients after treatment. Serum total and LDL cholesterol remained within the normal range in all patients before and after therapy. No significant changes were observed in serum triglyceride, apolipoprotein B and lipoprotein(a) concentrations. Fasting insulin levels and insulin resistance as analyzed by homeostasis model assessment were reduced significantly after therapy. No changes in BMI were observed. Administration of oral contraceptive pills signifiCantly reduced the hirsutism score and hyperandrogenemia. CONCLUSION(S): Oral contraceptive pills containing low-dose ethinyl estradiol and desogestrel are effective in controlling hyperandrogenism and hirsutism and ameliorate the abnormal metabolic profile of women with hirsutism.     

Pregnancy risk among oral contraceptive pill, injectable contraceptive, and condom users in Uganda, zimbabwe, and Thailand

OBJECTIVE: To estimate the probability of pregnancy for oral contraceptive pill (OCP), injectable contraceptive, and condom users in Uganda, Thailand, and Zimbabwe. METHODS: This study is a secondary analysis of 5,224 women who participated in a prospective study evaluating the association between hormonal contraception and human immunodeficiency virus (HIV) acquisition. RESULTS: The overall 12-month cumulative probability of pregnancy of injectable contraceptive users was 0.6% (95% confidence interval [CI] 0.3-1.0), with similar risks in Uganda (0.3%, 95% CI 0-0.7), Thailand (0.6%, 95% CI 0-1.2), and Zimbabwe (1.0%, 95% CI 0.3-1.7). The 12-month cumulative probability of pregnancy for OCP users was 9.5% (95% CI 8.1-11.0%), with similar risks of pregnancy in Uganda and Zimbabwe (14.6%, 95% CI 11.7-17.4; and 10.2%, 95% CI 8.0-12.5, respectively) but substantially lower risk in Thailand (0.5%, 95% CI 0-1.2). The overall 12-month cumulative probability of pregnancy for women intending to use a given method at baseline was 2.0% (95% CI 1.4-2.6%) for injectable contraceptives, 15.7% (95% CI 14.1-17.3%) for OCPs, and 25.8% (95% CI 23.2-28.4) for condoms. Women in Thailand experienced lower pregnancy risk with condoms (18.4%, 95% CI 11.1-25.7) than in Uganda (29.5%, 95% CI 25.7-33.4), and Zimbabwe (23.3%, 95% CI 19.4-27.2). CONCLUSION: The overall risk of pregnancy for injectable contraceptive users was substantially lower than for oral contraceptive pill users. However, Thai participants had similarly low cumulative pregnancy probabilities for both methods. Women receiving contraceptive counseling should be informed that their experience with a given method may differ from the average or typical-use pregnancy rates often discussed during contraceptive counseling. Tailored counseling is necessary for women to make informed choices. LEVEL OF EVIDENCE: II.     

Impact of oral contraceptive pill use on premenstrual mood: predictors of improvement and deterioration

OBJECTIVES: The purpose of this study was to estimate risk factors for the deterioration and improvement of premenstrual mood disturbance with oral contraceptive pill use. STUDY DESIGN: Predictors of the deleterious and beneficial effects of oral contraceptive pill use on premenstrual mood were analyzed with the use of logistic regression in a nested case-control study within a community-based cohort of 976 premenopausal women in Massachusetts. RESULTS: Of 658 women who were using oral contraceptive pills, 16.3% of the women reported oral contraceptive pill-related premenstrual mood deterioration, and 12.3% of the women reported premenstrual mood improvement. In adjusted models, previous depression was the only significant predictor of mood deterioration (odds ratio, 2.0; 95% CI, 1.1-3.8); early-onset premenstrual mood disturbance and dysmenorrhea were significant predictors of oral contraceptive pill-related mood improvement (odds ratio, 3.1 [95% CI, 1.9-5.2] and odds ratio, 2.3 [95% CI, 1.4-3.9], respectively). CONCLUSION: Oral contraceptive pills do not influence premenstrual mood in most women. Premenstrual mood is most likely to deteriorate in women with a history of depression and to improve in women with early-onset premenstrual mood disturbance or dysmenorrhea.     

Use of oral contraceptives and uterine fibroids: results from a case-control study.

OBJECTIVE: To analyse the association between oral contraceptive use and the risk of uterine fibroids. DESIGN: We considered data collected in a case-control study on risk factors for uterine fibroids. PARTICIPANTS: We studied 843 women with uterine fibroids, whose clinical diagnosis dated back no more than two years. Controls were 1557 non-hysterectomised patients younger than 55 years admitted for acute, non-gynecological, non-hormonal, non-neoplastic conditions. RESULTS: A total of 254 cases (30.1%) and 360 controls (23.1%) reported ever using oral contraceptives: the odds ratio (OR) for ever vs never users was 1.1 (95% CI 0.8-1.3). The risk in current users was below unity when compared with never users (OR 0.3, 95% CI 0.2-0.6), while ex-users had a risk of fibroids comparable with never users (OR 1.1, 95% CI 0.9-1.4). The risk of uterine fibroids decreased with duration of oral contraceptive use: compared with never users, the estimated OR was 0.8 (95% CI 0.5-1.2) in ever users for four to six years and 0.5 (95% CI 0.3-0.9) for seven years or more (chi2 trend = 4.6, P = 0.03). CONCLUSIONS: Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.     

Influence of oral contraceptive use on the risk of adult-onset vulvodynia

OBJECTIVE: To examine the association of adult-onset vulvodynia with oral contraceptive use. STUDY DESIGN: We conducted a population-based study of 177 women experiencing vulvar pain consistent with clinical criteria for vulvodynia and community-matched controls. Analyses were repeated and validated in clinically confirmed clinic-based and population-based cases and matched controls. RESULTS: In our analyses of population-based cases and controls, oral contraceptive use was associated with a nonsignificant, 30% increase in the risk of vulvodynia (95% CI 0.7-2.3) and was highest among women whose first use occurred before age 18 (OR = 2.5, 95% CI 1.1-5.8). These findings were similar when restricted to clinically confirmed cases. CONCLUSION: These findings do not support the strong associations observed in clinic-based studies. In our study, clinically confirmed clinic-based cases, as compared to population-based cases, were more often oral contraceptive users, earlier-age users and users for longer periods. Thus, observational studies using clinic-based cases might not adequately represent oral contraceptive use in all women with vulvodynia.     

Use of oral contraceptives and uterine fibroids: results from a case-control study

Objective To analyse the association between oral contraceptive use and the risk of uterine fibroids.
Design Participants We considered data collected in a case-control study on risk factors for uterine fibroids.
Participants We studied 843 women with uterine fibroids, whose clinical diagnosis dated back no more than two years. Controls were 1557 non-hysterectomised patients younger than 55 years admitted for acute, non-gynecological, non-hormonal, non-neoplastic conditions.
Results A total of 254 cases (30.1 %) and 360 controls (23.1 %) reported ever using oral contraceptives: the odds ratio (OR) for ever vs never users was 1–1 (95% CI 0-8–1.3). The risk in current users was below unity when compared with never users (OR 0.3,95% CI 0.2–0.6), while ex-users had a risk of fibroids comparable with never users (OR 1. I, 95% CI 0.9–1.4). The risk of uterine fibroids decreased with duration of oral contraceptive use: compared with never users, the estimated OR was 0.8 (95% CI 0.5–1.2) in ever users for four to six years and 0.5 (95% CI 0.349) for seven years or more (trend = 4.6,   P = 0.03  ).
Conclusions Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.     

Lipid and lipoprotein changes associated with oral contraceptive use: a randomized clinical trial

To determine the effects of oral contraceptives on lipids and lipoproteins over a six-month period, we randomized 266 women into four oral contraceptive groups: ethinyl estradiol 35 micrograms plus ethynodiol diacetate 1 mg, ethinyl estradiol 30 micrograms plus levonorgestrel 0.15 mg, ethinyl estradiol 35 micrograms plus norethindrone 1 mg, and ethinyl estradiol 35 micrograms plus norethindrone 0.5 and 1 mg (biphasic). For all groups, total cholesterol increased 5.9-9.1% from baseline values over the six months. Triglycerides increased with all preparations, with the ethynodiol diacetate group (37.6%) and the biphasic norethindrone group (45.3%) showing the greatest increase. Low-density lipoprotein cholesterol increased 10-15.6% among the groups; low-density lipoprotein-apolipoprotein B changed proportional to the low-density lipoprotein cholesterol increases. All groups except the ethynodiol diacetate group showed a decrease of high-density lipoprotein cholesterol, with the levonorgestrel group (8.7%) and biphasic norethindrone group (4.5%) showing the largest declines. Apolipoprotein A-1 increased in all groups, with the ethynodiol diacetate preparation (19.3%) showing the greatest increase and the levonorgestrel preparation (3.2%) showing the smallest increase from baseline values. The changes in apolipoprotein A-1 were out of proportion to the changes in high-density lipoprotein cholesterol, suggesting that the high-density lipoprotein particle may be undergoing some type of metabolic alteration.     

Are factor V Leiden carriers who use oral contraceptives at extreme risk for venous thromboembolism?

BACKGROUND: Major concern was raised by an earlier study regarding oral contraceptive use in women with the factor V Leiden mutation. A more than 30-fold increase in relative risk for venous thromboembolism was reported; for homozygotes, the relative risk was as much as 100-fold or more. OBJECTIVE: To replicate the reported risk estimates with a new population-based case-control study. METHODS: Eighty women with a diagnosis of venous thromboembolism were consecutively identified and compared with population-based controls (n = 406). Factor V Leiden mutation was identified by genotype analysis. The evaluation was performed with conditional logistic regression (matched for 5-year age group). RESULTS: Matched, adjusted odds ratios (OR) for idiopathic venous thromboembolism in women without and with the factor V Leiden mutation who used oral contraceptives were 4.1 (95% confidence interval (CI) 2.1-7.8) and 10.2 (95% CI 1.2-88.4), respectively. The adjusted OR for factor V Leiden carriers was 2.0 (95% CI 1.0-4.4). The OR for women with the factor V Leiden mutation and oral contraceptive use versus no factor V Leiden mutation and no oral contraceptive use was 10.2 (95% CI 3.8-27.6). CONCLUSION: The results confirm the increased relative risk of idiopathic venous thromboembolism for users of oral contraceptives and factor V Leiden carriers. However, we suspect that the true risk for women who are factor V Leiden carriers may be increased two- to four-fold rather than seven-fold or more, and that the risk for the combination of factor V Leiden and oral contraceptive use may be increased in the order often- to 15-fold rather than over 30-fold.     

Contraceptive methods and risk factors of cardiovascular diseases in Tehranian women: Tehran Lipid and Glucose Study.

Combined oral contraceptive (COC) users were reported to be at high risk for vascular thromboembolism and cardiovascular diseases. This cross-sectional study was aimed at determining the prevalence of cardiovascular risk factors in COC users and non-users in Tehran in 1999. The subjects were 2480 married women aged 15-49 years among the 15 000 participants in the Tehran Lipid and Glucose Study. The method of contraception (COCs, intrauterine devices (IUDs), condoms or coitus interruptus) was determined by questionnaire. Blood pressure, height and weight were measured. A 12-14 h fasting blood sample was taken for the determination of serum glucose, cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Two-hour postprandial plasma glucose, after 75 g oral glucose, was measured. Coitus interruptus, COC, condom and IUD were used in 48, 11, 4 and 5% of the individuals, respectively; 32% used no contraception. Serum cholesterol, triglycerides, HDL and LDL rates were within normal limits in all groups. No significant differences were observed in blood pressure, cholesterol, triglycerides and LDL between COC users and non-users. The present findings reveal the safety of COC pills in a group of Tehranian women. We recommend usage of COC pills in these women with respect to the background and confounding factors.     

Lipid effects of hormone replacement therapy with sequential transdermal 17-beta-estradiol and oral dydrogesterone

OBJECTIVE: To assess the effects on lipid and lipoprotein levels of a combination therapy of matrix patch and oral sequential dydrogesterone. METHODS: The lipid effects of transdermal estradiol (E2) (80 microg/day continuously) and oral dydrogesterone (10 mg from days 15-28 of each cycle) were assessed in a multicenter, prospective, open, baseline-controlled study. Subjects were 42 healthy, postmenopausal women who had not had hysterectomies. Fasting blood samples were taken at baseline, day 14 of cycle 3 (estrogen alone), and day 25 of cycle 6 (estrogen and progestogen). The main outcome measures were changes from baseline in total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides after six cycles. RESULTS: Thirty-six subjects completed six cycles and in the 28 with complete data, HDL cholesterol increased by 10.6% from 65.25 to 72.2 mg/dL (95% confidence interval [CI] 2.32, 11.58, P = .005) and LDL cholesterol fell by 5.1% from 130.9 to 124.3 mg/dL (95% CI 13.9, 1.16, P = .07). There was a nonsignificant decrease in LDL cholesterol from 130.9 at baseline to 124.3 mg/dL at 6 months and in triglycerides from 110.6 to 107.1 mg/dL. CONCLUSION: Sequential treatment with transdermal E2 and oral dydrogesterone increased HDL cholesterol, without the accompanying increase in triglycerides that occurs with oral estrogen replacement therapy.     

Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension

OBJECTIVE: The purpose of this study was to evaluate prospectively midtrimester homocysteine concentration levels for the prediction of superimposed preeclampsia in women with chronic hypertension. STUDY DESIGN: Between March 1, 2000, and February 1, 2002, pregnancies that were complicated by chronic hypertension that required medication had homocysteine, vitamin B(12), and folate concentrations measured between 16 and 20 weeks of gestation. All women received folate supplementation. An upper limit threshold for increased homocysteine was defined as the mean value plus 2 SDs. RESULTS: Fifty-seven women were enrolled. Mean homocysteine concentration levels were 5.1+/-1.7 micromo/L for the 16 women who had preeclampsia compared with 4.7+/-1.3 micromo/L for the 41 women without preeclampsia (P=.56). Two of 16 women with preeclampsia (13%) had concentration levels that exceeded the 95th percentile (6.9 micromo/L) compared with 2 of 41 women (5%) without preeclampsia (P=.31). The sensitivity and specificity were 13% (95% CI, 1.6-38.3) and 95.1% (95% CI, 83.5-99.4), respectively. CONCLUSION: Second-trimester homocysteine concentration levels were not helpful in the prediction of preeclampsia in chronically hypertensive women.     

Conception delay after oral contraceptive use: the effect of estrogen dose

A significant delay was observed in conception among 248 former oral contraceptive (OC) users compared with women discontinuing other methods of contraception (n = 1,365). The mean time to conception was 5.88 cycles (95% confidence interval [CI] 5.38, 6.38) for former OC users and 3.64 cycles (95% CI 3.49, 3.79) after other contraceptives. Women discontinuing OCs with higher doses of estrogen (greater than or equal to 50 micrograms) had greater conception delays than those on lower estrogen doses who, in turn, had longer delays than other method users. Oral contraceptive use was associated with significant reductions in conception for each of the first six cycles after discontinuation. This study provides further evidence for a direct effect of oral contraception on delayed conception, suggests that the delay lasts longer than previously thought, and finds that the probability of conception after OC discontinuation depends on the estrogen dose of the OC.     

Oral contraceptive use and risk of endometriosis. Italian Endometriosis Study Group.

OBJECTIVE: To analyse the association between use of oral contraception and risk of pelvic endometriosis. DESIGN: We compared use of oral contraception in women with and without endometriosis. PARTICIPANTS: Eligible for the study were women with primary or secondary infertility (n = 393) or chronic pelvic pain (n = 424), requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy. RESULTS: Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0-3.3) in current users and 1.6 (95% CI 1.1-2.4) in ex-users. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1-3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9-2.5) for those reporting their last use > or = 5 years before interview. CONCLUSIONS: The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.     

Oral contraceptive use and risk of endometriosis

Objective To analyse the association between use of oral contraception and risk of pelvic endometriosis.
Design We compared use of oral contraception in women with and without endometriosis.
Participants Eligible for the study were women with primary or secondary infertility (   n = 393  ) or chronic pelvic pain (   n = 424  ). requiring laparoscopy, consecutively observed between September 1995 and January 1996 in 15 obstetrics and gynaecology departments in Italy.
Results Out of the 817 women included in the study, 345 had a diagnosis of endometriosis; 164 (47.5%) women with endometriosis and 139 (29.4%) without the disease reported ever using oral contraception. In comparison with never users the estimated odds ratios (OR) of endometriosis were 1.8 (95% CI 1.0–3.3) in current users and 1.6 (95% CI 1.1–2.4) in exusers. No clear relation emerged between duration of oral contraceptive use and risk of endometriosis. In comparison with never users, the OR was 1.8 (95% CI 1.1–3.0) for women reporting their last use of oral contraception < 5 years before interview and 1.5 (95% CI 0.9–2.5) for those reporting their last use >5 years before interview.
Conclusions The study suggests that oral contraception is associated with an increased risk of endometriosis but this finding is based on a selected population and cannot generalised to all women with endometriosis.     

Flaxseed dietary supplement versus hormone replacement therapy in hypercholesterolemic menopausal women

OBJECTIVE: To assess serum lipid changes by a phytoestrogen dietary supplement compared with oral estrogen-progesterone replacement in hypercholesterolemic menopausal women. METHODS: Twenty-five menopausal patients with total cholesterol greater than 6.2 mmol/L (240 mg/dL), a cholesterol/high-density lipoprotein-cholesterol ratio greater than 4.5 and triglycerides less than 3.5 mmol/L (310 mg/dL) after a 4-month diet, were randomized to add 40 g/day of crushed flaxseed to their diet or to take daily 0.625 mg of conjugated equine estrogens alone (hysterectomy, n = 10) or combined with 100 mg of micronized progesterone (intact uterus, n = 15). After 2 months of treatment, both groups continued the diet alone during a 2-month washout period before crossing over to the alternate treatment for 2 more months. RESULTS: Differences were found between hormone replacement therapy and flaxseed respectively for decrease of low-density lipoprotein cholesterol (3.8 +/- 0.2 versus 4.4 +/- 0.2 mmol/L) (148 +/- 8 versus 170 +/- 8 mg/dL) (P =.10), increase of high-density lipoprotein cholesterol (1.6 +/- 0.04 versus 1.3 +/- 0.03 mmol/L) (62 +/- 1 versus 50 +/- 1 mg/dL) (P =.001), and increase of apolipoprotein A-1 (1.71 +/- 0.07 versus 1.42 +/- 0.05 g/L) (P =.003). These changes were not related to modifications in diet, exercise, or anthropometric measurements evaluated in parallel. Both treatments produced similar decreases in menopausal symptoms and in glucose and insulin levels. Only hormone replacement therapy as compared with flaxseed induced an elevation of sex hormone binding globulin (P =.004), lowered fibrinogen (P =.08), and plasminogen activator inhibitor type 1 (P =.01). CONCLUSION: Although 40 g of flaxseed is as effective as oral estrogen-progesterone to improve mild menopausal symptoms and to lower glucose and insulin levels, only hormone replacement therapy significantly improves cholesterol profile in hypercholesterolemic women and favorably modifies markers related to cardiovascular health.     

Effects of estrogen dose and smoking on lipid and lipoprotein levels in postmenopausal women

The joint effects of conjugated estrogen use, age, body mass index, and smoking on plasma lipid and lipoprotein levels were assessed in 585 women who used oral estrogen and 1093 women who did not who participated in the Walnut Creek Contraceptive Drug Study. Whether administered daily or cyclically, conjugated estrogen was associated with reductions in low-density lipoprotein cholesterol levels and increases in high-density lipoprotein cholesterol and triglyceride levels. The adjusted mean low-density lipoprotein cholesterol concentration was 132 mg/dl for women who used conjugated estrogen in a dose ≥ 1.25 mg/day; the adjusted corresponding mean concentration was 147 mg/dl for postmenopausal women who did not use estrogen. A dose-response pattern was demonstrated between conjugated estrogen and low- and high-density lipoprotein cholesterol levels. A maximum low-density lipoprotein cholesterol level reduction was reached at a dose of 1.25 mg, suggesting a saturation phenomenon. Stepwise dose-response increases in high-density lipoprotein cholesterol levels were also found with estrogen therapy, with a maximum increase of 8 to 10 mg/dl observed with the 1.25 mg dose. Estrogen-related rises in low-density lipoprotein cholesterol levels and decreases in high-density lipoprotein cholesterol levels were offset by 2 to 3 mg/dl in women who smoked. It may be concluded, therefore, that among postmenopausal women, low-risk lipoprotein profiles as assessed by low- and high-density lipoprotein cholesterol levels are found in nonsmokers whose postmenopausal hormone therapy includes the equivalent of a conjugated estrogen dose of 1.25 mg.