Nutritional effects of oral contraceptives

In this research we investigate factors associated with nonuse of condoms for sexually active Botswana women. Nationally represented data, drawn from the 2004 Botswana AIDS Impact Survey, were used. A sample of 5,236 women aged 15–49 who have had sexual intercourse was considered for the analysis. Cross-tabulations were used to gain insights into the phenomena to be reinforced with logistic regression. Through logistic regression analysis, we reveal that the relative odds of having had no HIV/AIDS tests, had an older sexual partner, and had sexual intercourse intoxicated under alcohol were significantly less among teenagers and women aged 20–34. It is shown that women with primary education were less likely to have been tested for HIV/AIDS and have had sexual intercourse while intoxicated. Christians were less likely to have had sexual intercourse while intoxicated. Last, women who did not use condoms at last sexual intercourse were significantly more likely to have had sexual intercourse while under the influence of alcohol, had older sexual partners, and believed that people cannot reduce their chances of getting HIV/AIDS by using a condom.     

Hemorheological effects of oral contraceptives

To determine the hemorheological effects of oral contraceptives, 50 healthy young women took no medication for 3 cycles. Subsequently they were randomized into group A and B. Group A took Diane-35, B took Microgynon each for 6 cycles. Finally 3 cycles without medication followed. Blood viscosity was quantified by ex vivo measurements of hematocrit, blood and plasma viscosity, red cell filterability, fibrinogen and colloid oncotic pressure. In group A fibrinogen rose at the end of the medication phase. In group B fibrinogen, blood and plasma viscosity increased on medication. The former 2 variables remained elevated even after discontinuation of the oral contraceptive. The data combined with those from the literature suggest that low-dose oral contraceptives lead to no biologically meaningful changes in blood rheology while higher doses induce limitations of blood fluidity which could be involved in the increment of cardiovascular risk by these medications.     

Modern oral contraceptives and dysmenorrhoea

Women with primary dysmenorrhoea not sufficiently helped by triphasic oral contraceptives (OCs) were offered a modern, low-dose monophasic OC containing 30 micrograms of ethinylestradiol and 150 micrograms of desogestrel. The study shows that for these women, the monophasic pill was the better alternative. The fact that 19 of 23 women who continue treatment on the monophasic OC indicates that this type of pill may be chosen as the first alternative for women with primary dysmenorrhoea.     

Anicteric hepatitis and oral contraceptives

Dr Ricardo Katz, Associate Professor of Medicine at the University of Chile, discussed the possible association of hepatitis with oral progestogens. He pointed out that, as in some Scandinavian countries, cholestatic jaundice was not uncommon in relation to the intake of oral gestogens in Chile. Several hundred cases of Icteric Hepatitis had been reported there, but evidence of Anicteric Hepatitis, associated with oral contraception, was accumulating. Dr Katz gave some figures from a study into prevention of post-transfusion hepatitis with gamma globulin. There were 2,343 subjects in the study; 173 of these were taking oral contraceptives at the time. Among those not on oral gestogens, only seven developed Anicteric Hepatitis, while of the 173 on oral gestogens, 27 did so. The condition was diagnosed by liver biopsy, which showed histological evidence of serious liver damage. Thus, nearly 15% of the women in this study who were taking oral contraceptives and had a transfusion showed serious liver damage without jaundice. Dr Katz said that while this situation might be peculiar to Chile, it was nevertheless of great importance and should be noted by doctors working in other countries.     

Statement on steroidal oral contraceptives

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.     

Liver tumors and oral contraceptives

In the past 6 years there has been an increase in the number of published reports of women with benign hepatic adenomas who had also been taking oral contraceptives. There have been 80 such reports. In 3 instances, patients have developed malignant hepatomas while taking oral contraceptives. Several oral contraceptive compounds have been implicated. Duration of such therapy has varied from 6 months to over 5 years. Pain with a palpable abdominal mass has usually been present. Rupture of the tumor with hemorrhage into the peritoneal cavity has been the most serious complication. The small number of recorded cases and the large number of women who have taken oral contraceptives suggest that this is a relatively rare complication.     

Thiamine status and oral contraceptives

Using $\text{in vitro}$ Stimulation of erythrocyte transketolase by thiamine pyrophosphate as an index of thiamine status, measurements were conducted on 20 healthy young women immediately prior to beginning treatment with combined-type oral contraceptives, then again after 3 cycles. Erythrocyte transketolase became more unsaturated by its cofactor during treatment, indicating the induction of a mild thiamine hypovitaminosis by oral contraceptives.