Glycemic status in women using combined oral contraceptive pill

This study was undertaken to determine the effects of low-dose combined oral contraceptives(OCs) containing 30 gm Ethinyl estradiol with 150 microg Levonorgestrel on carbohydrate metabolism by a glycaemic variable -- fasting blood glucose level. It is now known that impairment of carbohydrate metabolism is a potential risk factor for cardiovascular disease and other metabolic disorder. Sixty women age between 15-35 years using OCs served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCP (Oral contraceptive pill) users for last one year group, three year group and five year group. The result showed that there were no significant differences on blood glucose level between users and non-users women. It is concluded that the cyclic administration of monophasic low dose OCs did not altered blood glucose levels and there by have no additional adverse impact on women health reaffirming the ongoing oral contraceptive pill distribution program.     

Contraceptive efficacy of the pill

Some women who use the pill are at a high risk of unplanned pregnancy. Health practitioners must evaluate drug medication data, gastrointestinal disturbances, and determine a patient's ability to use the pill effectively to identify those at high risk. Of the many types of contraceptives, the pill still comes the closest to being the most effective contraceptive. Nevertheless, the expected failure rate is lower than actual user rate due to a variety of reasons, such as forgetfulness in taking the tablets and temporary malabsorption problems. Since combined preparations of the pill such as the triphasic pill effect the hypothalamic-pituitary region, the endometrium, and the cervical mucosa, one would expect a high level of protection. Evidence indicates, however, that the triphasic pill is comparatively less effective than the fixed dose oral contraceptives. Additionally, studies reveal that certain women should not use oral contraceptives (e.g. women who smoke) because of increased risk to their health. Several benefits have been identified, however, in those women who are not considered high risk, such as a reduction in dysmenorrhea and irregular menstrual bleeding. Unfortunately, little is known on how to detect noncompliant users or how to motivate them to use the pill effectively. Yet research into alternative delivery routes, such as dermal patches and implants, has not reached the commercial level. In Australia, 25% of women of reproductive age choose oral contraceptives.     

Effects of low dose oral contraceptives on serum total cholesterol, TAG, HDL-C & LDL-C levels in contraceptive users

This study was done to appraise the effects of low-dose oral contraceptives (OC(s)) containing synthetic estrogen ethinyl estradiol and synthetic progestin levonorgestrel on serum total cholesterol, TAG, HDL-C and LDL-C levels. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non-users were selected for control group. Experimental group was again subdivided into OCP users for last one-year group, three-year groups and five-year group. The results showed that there were no significant differences on most of the study parameters between users and non-users women. But there was a significant accession of serum triacylglycerol only in OCP user groups. The results hint that low-dose oral contraceptives regimens partly impaired the lipid metabolism. So, the safeness of low-dose OCP used in National Population Control Program is further inspired. The value of studied parameters for serial longer continuation of OCP uses need to be renegotiated.     

Oral contraceptives and hepatocellular carcinoma

A series of 26 white women aged under 50 who developed hepatocellular carcinoma in a non-cirrhotic liver were studied for the possible role of oral contraceptives. Eighteen of the women had used the "pill" for a median of eight years. Over 1300 women whose use of the pill had been determined in another study served as controls. Patients and controls were divided into five age and four calendar groups and the relative risks associated with oral contraceptives calculated by multivariate analysis. Short term use of the pill was not associated with an increased risk of tumour development; nevertheless, use for eight years or more was associated with a 4.4-fold increased risk (p less than 0.01). When patients with markers of hepatitis B virus infection were excluded the relative risk was 7.2 (p less than 0.01). In both instances the absolute risk for developing hepatoma remained low.     

Serum copper in rural women taking combined oral contraceptive

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.     

Pregnancy induced hypertension: evidence for increased cell membrane permeability to sodium

In a cross sectional study of 137 women of childbearing age (16-40) the effects of normal pregnancy, hypertensive pregnancy, and oral contraceptives on red cell electrolyte content and sodium efflux rates were examined and the results compared with values in a control group of normotensive, non-pregnant women. Efflux rate constants were significantly increased in normotensive pregnancy and in women taking oral contraceptives. This was associated with a significant increase in sodium permeability in the contraceptive group. A much larger increase in sodium permeability and efflux rate constant was seen in the hypertensive group. The results permit a hypothesis that the hormonal changes induced by pregnancy and oral contraceptives increase membrane permeability to sodium and stimulate sodium efflux. The rise in blood pressure associated with use of oral contraceptives may have a similar aetiology to that occurring in pregnancy induced hypertension.     

Oral contraceptives,serum folate,and hematologic status

Previous reports have suggested deleterious effects on folate balance in users of contraceptives. A study of folate in 526 women attending a family-planning clinic demonstrated, both with the Lactobacillus casei assay and with a new radioassay, that the mean serum folate level for women taking oral contraceptives was not significantly lower than that for women in a control group. There was no correlation between serum folate level and length of time oral contraceptives were taken. Also, there was no macrocytosis or hypersegmentation of polymorphonuclear leukocytes and no case of macrocytic anemia in the 280 users of oral contraceptive agents. Probably, oral contraceptive agents do not cause folate deficiency anemia in otherwise normal subjects.     

Chronic inflammatory bowel disease, cigarette smoking, and use of oral contraceptives: findings in a large cohort study of women of childbearing age

Since the start in 1968 of the Oxford Family Planning Association contraceptive study 31 women have developed ulcerative colitis and 18 have developed Crohn's disease, giving incidences of 0.15 and 0.09/1000 woman years respectively. The incidence of ulcerative colitis in women who were non-smokers on entry to the study was 0.17/1000 woman years and the incidence in smokers was 0.11/1000 woman years. The findings for Crohn's disease were entirely different, the corresponding incidences being 0.05 and 0.17/1000 woman years respectively. Both ulcerative colitis and Crohn's disease were more common among women currently using oral contraceptives than among those not doing so. Incidences per 1000 woman years for ulcerative colitis were 0.26 in users and 0.11 in non-users; for Crohn's disease the incidences were 0.13 and 0.07 respectively. Though the association between the use of oral contraceptives and chronic inflammatory bowel disease cannot be regarded as established, the effects of smoking have been shown consistently in many studies. This observation provides an important clue to the aetiology of chronic inflammatory bowel disease.     

Oral contraceptives and nonfatal myocardial infarction.

We obtained information on 107 women younger than 46 years who were discharged from a hospital with a diagnosis of acute myocardial infarction. In the series 26 women were otherwise apparently healthy and potentially childbearing. Among these 26 women, 20 (77%) were taking oral contraceptives just prior to admission, and one was taking conjugated estrogens. Among 59 control women, 14 (24%) were taking oral contraceptives and one was taking conjugated estrogens. The relative risk estimate, comparing oral contraceptive users with nonusers, is 14 with 90% confidence limits of 5.5 and 37. All but two of the 26 women were cigarette smokers. While this illness is rare in most healthy young women, the risk in women older than about 37 years who both smoke and take oral contraceptive appears to be high.     

Association between diaphragm use and urinary tract infection

We conducted independent case-control and retrospective cohort investigations to assess the relationship between diaphragm use and urinary tract infection (UTI). In the former, we compared diaphragm use and vaginal flora among 114 women with acute UTI and 85 women with acute urinary tract symptoms and no UTI. In the latter study, we ascertained the incidence of UTI in 192 diaphragm users and 182 women taking oral contraceptives during a mean follow-up of 9.4 months. Both studies demonstrated a significantly increased risk of UTI in diaphragm users: relative odds were 2.0 in the case-control study and the relative risk was 2.5 in the retrospective cohort study. Vaginal colonization with Escherichia coli was significantly greater in diaphragm users. The incidence of UTI in the cohort study was 26.6 per 1,000 patient-months for diaphragm users and 8.9 per 1,000 patient-months for women taking oral contraceptives. The increased risk of UTI in diaphragm users could not be attributed to differences in age, parity, sexual activity, or previous UTI.     

Kaiser study links "pill" and risk of hypertension

A continuing study of the relationship between oral contraceptives and hypertension is being conducted at the Kaiser Permanente Medical Center in Walnut Creek, California. All 12,000 subjects participating between December 1968 and December 1971 initially received a battery of tests, medical questionnaires and an examination by both a gynecologist and an internist at Kaiser's Automated Multitest Laboratory (AML), and were subsequently divided into 3 groups; 3569 never (pill) users, mean age 34.5 years; 4252 past users, mean age 13.6 years; and 3851 current users, mean age 29.8 years. Women whose hypertensions was diagnosed at the initial AML examination were classified by age and oral contraceptive use. New cases of hypertension occurred more frequently among never users or past users. 5 new cases of the disease occurred in 3569 women who had never taken oral contraceptives--a rate of 1.4 per 1000. 4 new cases were detected among 4252 past users--a rate of .9 per 1000, while 19 cases were detected among 4252 past users-a rate of 4.9 per 1000. The total age-adjusted rate for current users was found to be 6 times that for never users (p .001). Incidence of hypertensive disease at entry into the study was higher for current users that for past or never users at every age level, except that under 25 years. Comparison of rates for past users and never users failed to show a consistent pattern of difference and the total age-adjusted rate between past and never users was similiar. The actual rate of occurrence of new cases in all 3 groups is though to be an underestimate because some women failed to return for repeat AML examinations. A review of all Kaiser clinic outpatient charts is in progress to detect missing data, and a second review is being conducted to allow computation of an incidence rate based on person-years of observation. Alaysis of currently accumulating data is planned within 6 months, and a report on the initial investigation, led by Dr. Savitri Ramcharan, appears in the book Oral Contraceptives and High Blood Pressure.     

Serum zinc status of rural women taking combined OC

This prospective case-control study was undertaken on 78 women between 15 to 45 years of age from rural area to see alteration of serum zinc due to oral contraceptive (OC) use. Of the subjects, 34 women was taken as controls having no history of taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. All of the women in the control group were advised to start consuming oral pill (Sukhi) for 3 consecutive cycles and at the 3(rd) month, 25 women were taken as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for 4 months onwards. Subjects were classified as follows on the basis of duration of oral contraceptive use: Group I (n=34) -- controls, Group II (n=25) -- 3 months, Group III (n=17) -- 4 months -- 2 years and Group IV (n=27) -- >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Zinc (microg/dl) by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer. MeanSD of Serum Zinc significantly reduced in all 3 contraceptive groups in comparison to controls (p<0.001). It was recommended to carry out further study including larger population from rural area to elucidate alteration in serum zinc and other trace elements to correlate with side effects caused by hormonal contraceptive so that attempt could be made to mitigate those.     

Ovarian neoplasms, functional ovarian cysts, and oral contraceptives

The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.     

Colonic Crohn's disease and use of oral contraception

The prevalence of use of oral contraception before the onset of disease was established in 100 consecutive women attending follow up clinics for inflammatory bowel disease. A significant excess of women with Crohn's disease confined to the colon had taken oral contraceptives in the year before developing symptoms (10/16 (63%] compared with women with small-intestinal Crohn's disease (12/49 (24%); p less than 0.02) and women with ulcerative colitis (3/35 (9%); p less than 0.0005). When the patient groups were matched for age and year of onset of disease usage of oral contraception before the onset of disease was still more common among women with isolated colonic Crohn's disease (9/12, 75%) than among those with ulcerative colitis (2/12 (17%); p less than 0.02) and was also more common than would be expected from reported figures for oral contraception in England and Wales (31.4% of women aged under 41; p less than 0.005). A survey of current patient records showed that isolated colonic disease was at least twice as common among women with Crohn's disease (63/218, 29%) compared with men (25/181, 14%; p less than 0.001). These data support the suggestion made previously that oral contraceptives may predispose to a colitis that resembles colonic Crohn's disease.     

Oral contraceptives and breast cancer: a national study

In a population based case-control study 433 New Zealand women aged 25-54 with newly diagnosed breast cancer were compared with 897 women selected at random from the electoral rolls. The relative risk of breast cancer in women who had ever used oral contraceptives was 0.94 (95% confidence interval 0.70 to 1.25). The relative risk in women aged 25-34 at diagnosis was estimated to be 2.2 (95% confidence interval 0.47 to 9.9) and in older women less than 1. Analyses of risk by duration of use of oral contraceptives, age at first use, and time since first use showed no adverse effect of the pill. In particular, there was no increased risk in women who had used oral contraceptives before the age of 25 or before their first pregnancy, even for prolonged periods. Given the high prevalence of use in New Zealand, this study provides strong evidence against the hypothesis that use of oral contraceptives at young ages increases the risk of breast cancer.     

Use of shopping centres in screening for hypertension

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.

Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient's arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.

The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.

     

Determinants of isolated systolic hypertension

Isolated systolic hypertension (ISH), defined as systolic blood pressure of 160 mm Hg or greater when the diastolic pressure is less than 95 mm Hg, is a common form of hypertension among the elderly. We collected incidence and prevalence data on ISH and evaluated several potential factors for its occurrence in the Framingham Heart Study during 16 biennial examinations. The factors evaluated were age, sex, all components of the blood pressure (systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure), Metropolitan relative weight, serum cholesterol level, serum uric acid level, cigarette smoking, ventricular heart rate, glucose intolerance, and hematocrit. The population at risk (1687 men and 1992 women) were those members of the Framingham cohort with a systolic blood pressure less than 160 mm Hg in the first four biennial examinations. Results showed ISH in 14.4% of the men and 22.8% of the women. Cumulative incidence rates were 418 per 1000 in men and 533 per 1000 in women. Significant risk factors for ISH were age, sex, all components of the blood pressure, and increased relative weight in women. We conclude that ISH is a highly prevalent disorder. Its major determinants are age, sex, increasing levels of blood pressure, and obesity in women.     

"Pills" relative safety gains further support

A symposium held in 1969 in Palm Springs, California on the current status of research and patient care in the field of oral contraceptives reviewed the relationship of the pill and various physiological complications. Alterations of blood coagulate factors were noted to occur in pill users, but women consuming progesterone-only pills did not show these changes. Other complications have stimulated study in areas of bile secretion, thyroid and pituitary function, and calcium metabolism in relation to the intake of orals.     

The effect of long term use of oral contraceptive pills on lipid metabolism

The effect of long-term use of oral contraceptive pills on lipid metabolism was the aim of this study. 200 healthy, multiparous women attending the family planning clinic in Ain Shams University Hospital, Cairo, were divided into two groups. The study group included 100 women using monophasic combined oral contraceptive pills, while the control group included 100 women using only IUDs for at least 5 uninterrupted years. Serum total lipids, cholesterol, triglycerides, and lipoproteins were estimated in both groups. It was found that serum cholesterol, triglycerides, and beta-lipoproteins were higher in pill users than in the IUD group. The level of alpha-lipoproteins showed a more significant drop in the serum of pill users than in the serum of the control group. None of these changes were correlated with body weight or duration of pill usage. The estimated serum level of total lipids was found to be high among pill users and not correlated with the duration of pill usage. This rise was insignificant in pill users having body weight less than 70 kg, but was significant in all other body weight groups.