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PubMed2003

New options in contraception for teenagers.

PURPOSE OF REVIEW: Unintended pregnancy continues to exact a considerable economic, social and personal cost in industrialized nations despite the ready availability of safe, reliable and highly effective methods of contraception. Adolescents still demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options that provide unique side effect profiles or delivery systems that could facilitate and improve compliance of contraceptive methods. RECENT FINDINGS: The recent launch of several new combination oral contraceptive pills with novel side effect profiles has expanded the choices for teenagers who choose to use a daily oral contraceptive. Of potentially greater interest is the recent availability of several nondaily contraceptives, as compliance remains a critical issue with successful contraceptive use in adolescents. SUMMARY: New contraceptive methods bring unique side effect profiles and delivery systems that may improve overall contraceptive compliance, especially among teenagers who are more prone to misuse from a wide array of side effect and compliance issues. Even the most accepted method, however, will not provide effective contraception if the process by which contraception is provided fails to address the unique concerns and lifestyle issues of each individual adolescent.

Absorbable Implants↗
PubMed1998

Contraceptive needs of women attending a genitourinary medicine clinic for the first time.

OBJECTIVE: To assess the need for, and potential uptake of, a contraceptive service within a genitourinary medicine (GUM) clinic. METHODS: 544 women, median age 17 years (range 13-54) including 142 teenagers, attending the Fife GUM clinics serving a semirural population of 350,000 for the first time in the 12 month period from 1 September 1995 to 31 August 1996 were interviewed. RESULTS: Contraception was required by 353, of whom only 5% (29) were at risk of unplanned pregnancy, although half (15) of these were teenagers. 23 of 29 (79%) stated that they would access contraception at a GUM clinic if it were available. Of women using contraception, 67% (217/324) were taking the oral contraceptive pill (OCP), of whom 177 obtained supplies from their general practitioners and were happy with this. However, 92/177 (52%) stated that they would access the OCP at GUM clinics if it were available. Overall, of the 243 women who stated that they would access contraception at the GUM clinic, 23 of whom were currently at risk of an unplanned pregnancy, the demand was principally for condoms and the OCP. CONCLUSION: The majority of women attending GUM clinics for the first time are using contraception, or have deliberately chosen not to do so. Only 5% were at risk of unplanned pregnancy. In general, the women using contraception were happy with their current source of contraception, but about two thirds would use a contraceptive service at GUM clinics if it were available at the time they were attending the clinic. It was found that teenagers accounted for half of those women at risk of unwanted pregnancy. However, the majority of teenagers requiring contraception would consider obtaining it from GUM clinics.

Adolescent↗
PubMed2001

Male hormonal contraceptives.

As the world human population continues to explode, the need for effective, safe and convenient contraceptive methods escalates. Historically, women have borne the brunt of responsibility for contraception and family planning. Except for the condom, there are no easily reversible, male-based contraceptive options. Recent surveys have confirmed that the majority of men and women would consider using a hormonal male contraceptive if a safe, effective and convenient formulation were available. Investigators have sought to develop a male hormonal contraceptive based on the observation that spermatogenesis depends on stimulation by gonadotropins, follicle-stimulating hormone (FSH) and luteinising hormone (LH). Testosterone (T) and other hormones such as progestins suppress circulating gonadotropins and spermatogenesis and have been studied as potential male contraceptives. Results from two large, multi-centre trials demonstrated that high-dosage T conferred an overall contraceptive efficacy comparable to female oral contraceptives. This regimen was also fully reversible after discontinuation. However, this regimen was not universally effective and involved weekly im. injections that could be painful and inconvenient. In addition, the high dosage of T suppressed serum high-density lipoprotein (HDL) cholesterol levels, an effect that might increase atherogenesis. Investigators have attempted to develop a hormonal regimen that did not cause androgenic suppression of HDL cholesterol and that was uniformly effective by suppressing spermatogenesis to zero in all men. Studies of combination regimens of lower-dosage T and a progestin or a gonadotropin-releasing hormone analogue have demonstrated greater suppression of spermatogenesis than the WHO trials of high-dosage T but most of these regimens cause modest weight gain and suppression of serum HDL cholesterol levels. Overall, the data suggest that we are close to developing effective male hormonal contraceptives. The focus is now on developing effective oral regimens that could be safely taken daily or long-acting depot formulations of a male hormonal contraception that could be conveniently injected every 3 - 6 months. In this article, we shall review the exciting new developments in male hormonal contraception.

Contraceptive Agents, Male↗
PubMed1997

Preventing unintended pregnancy: the cost-effectiveness of three methods of emergency contraception.

OBJECTIVES: This study examined the cost-effectiveness of emergency contraceptive pills, minipills, and the copper-T intrauterine device (IUD) as emergency contraception. METHODS: Cost savings were modeled for both (1) a single contraceptive treatment following unprotected intercourse and (2) emergency contraceptive pills provided in advance. RESULTS: In a managed care (public payer) setting, a single treatment of emergency contraception after unprotected intercourse saves $142 ($54) with emergency contraceptive pills and $119 ($29) with minipills. The copper-T IUD is not cost-effective as an emergency contraceptive alone, but savings quickly accrue as use continues. Advance provision of emergency contraceptive pills to women using barrier contraceptives, spermicides, withdrawal, or periodic abstinence saves from $263 to $498 ($99 to $205) annually. CONCLUSIONS: Emergency contraception is cost-effective whether provided when the emergency arises or in advance to be used as needed. Greater use of emergency contraception could reduce the considerable medical and social costs of unintended pregnancies.

Contraceptives, Oral, Hormonal↗
PubMed1996

Attitudes to current oral contraceptive use and future developments: the women's perspective.

OBJECTIVES: The study was planned to determine current trends in contraceptive usage and to examine the attitudes, needs and preferences of women with respect to oral contraceptives. METHODS: Semi-structured interviews were carried out with women (n = 1201, aged 16-45 years) in Germany, the UK and France. RESULTS: The study revealed that oral contraceptives were the most popular method of contraception employed, followed by condoms, and that the majority of respondents were aged 16-19 years when they first used an oral contraceptive. An important finding of the study was that an oral contraceptive was first used only after having sexual intercourse for the first time (within 1 year), emphasizing the importance of effective contraceptive information and education for adolescents. Regarding non-contraceptive health benefits, protection from ovarian and endometrial cancer was perceived by respondents to be of the greatest importance; however, few women were spontaneously aware of this benefit. When given a number of different oral contraceptive intake options to assess, the established 'once daily for 21 consecutive days' option remained the most popular, although a 'once weekly' alternative was cited by many women. When asked about the preferred frequency of menstrual bleeding, there was a polarization between women favoring the normal monthly bleed and those wanting a 'no-bleed' regimen. CONCLUSION: Women are poorly informed about oral contraceptive use, and are largely unaware of the important long-term non-contraceptive benefits. Many women would prefer alternative pill intake options and a significant number would favor a 'no-bleed' regimen.

Adolescent↗
PubMed2006

Knowledge and practice of emergency contraception among female undergraduates in the University of Lagos, Nigeria.

OBJECTIVES: To assess the level of knowledge and practice of emergency contraception among female undergraduates in University of Lagos and to determine the factors that influence knowledge and practice of emergency contraception among female undergraduates. DESIGN: Cross-sectional descriptive study. SETTING: The University of Lagos, Lagos, South-West, Nigeria between August 2003 and March 2004. SUBJECTS: Four hundred and eighty randomly selected female undergraduate students. RESULTS: The findings revealed that 67.8% of the respondents reported knowing about emergency contraception. More than half (56.1%) were sexually active and of this group, 96.8% had ever practiced contraception with only 33.9% having ever practiced emergency contraception. However, only 37.8% and 36.3% of respondents who had reported knowing about emergency contraception knew the correct time frame for effective use, and correctly identified emergency contraceptives respectively. Among those who were aware of, and had used emergency contraception, 34.1% obtained their information from health care providers, while the larger majority obtained from friends. Knowledge and practice of emergency contraception was found to be directly related to age, level of study, medical education, marital status, sexual activity, previous history of use of contraceptives and previous history of induced abortion. CONCLUSION: Education efforts that focus on the training of health care providers and young adults on emergency contraception with regards to available methods and correct timing of use would greatly improve women's access to and effective use of this method in Nigeria.

Adolescent↗
PubMed2002

Knowledge and use of emergency contraception in a tertiary referral unit in a developing country.

BACKGROUND: The promotion and availability of emergency contraception have the possibility of reducing the number of unwanted pregnancies, leading to fewer pregnancy terminations and possibly to reduced maternal morbidity and mortality. METHODS: The aims of the study were to determine the knowledge and use of emergency contraception in two groups of women: those requesting emergency contraception after sexual misadventure and another group of women requesting termination of pregnancy. A retrospective analysis was performed on all files of patients who requested emergency contraception over a 12-month period. Telephone interviews were conducted 1 year later. Structured questionnaires regarding knowledge and usage of emergency contraception were also administered to patients requesting termination of pregnancy. RESULTS: Seventy-six women requested emergency contraception over the 12-month period. Forty-one (53.9%) did not attend the follow-up visit. Only two patients used condoms. A total of 39 patients were contacted by telephone after 1 year. Of these, 18 did not use any contraception, although five were sexually active. In the group of women who requested termination of pregnancy, 44% had not previously used contraception. In all, 40% did not know about emergency contraception, 36% had not used it previously and 24% had used it previously. CONCLUSIONS: Lack of knowledge concerning emergency contraception can contribute to the number of legal abortions requested. There is an urgent need to address current education for users and providers on the use of emergency contraception.

Adolescent↗
PubMed2002

Oral contraception: trends over time.

Since their introduction in 1960, oral contraceptives have undergone an evolution in content and dosage. The doses of the steroid components of combination oral contraceptives have been dramatically decreased since the first formulations. Ethinyl estradiol is now used as the estrogenic component of most combination oral contraceptives. The majority of progestins currently used in combination oral contraceptives are derivatives of 19-nortestosterone. However, drospirenone, which is combined with ethinyl estradiol in a new combination oral contraceptive, is a novel progestin that is derived from 17 alpha-spirolactone and is an analogue of spironolactone. The extremely low failure rate with ideal use of combination oral contraceptives is seldom duplicated in actual usage. Women often discontinue combination oral contraceptives within the first 2 months due to side effects that would likely have decreased over time. Although there are some areas of increased health risk with combination oral contraceptives, the benefits far outweigh the potential risks. In addition to providing effective contraception, combination oral contraceptives are sometimes used for their many noncontraceptive health benefits--e.g., treatment of menstrual irregularities and management of premenstrual symptoms. The most practical solution to the problem of poor compliance appears to lie in providing adequate education and counseling to women using combination oral contraceptives so that they know how to use them properly and what side effects they might expect. Patients also need to be given the facts about potential increases in the risk of certain conditions to help correct any misperceptions.

Adult↗
PubMedDate not supplied

[Contraceptive methods used by young women in the township of Lomé (Togo)].

Despite intensive development of reproductive health services among Togolese youth over the past ten years, contraceptive prevalence remains low, particularly among young women. To help understand the reasons for the low rate of use of reproductive health services by young women (adolescents and young adults) and to assess prevalence of their contraceptive use in Lomé. In a cross-sectional study in the five precincts of Lomé township from March 08, 1999, to April 17, 1999, approximately 500 adolescent girls and young women (aged 10-24 years) were interviewed according to a semi-structured questionnaire. The variables studied were: social and demographic characteristics; knowledge about family planning, including whether they had discussed sexual issues with their parents; conditions of contraceptive use (method used by the interviewee or her sexual partner, who made the decision, geographical and financial accessibility of the method); suggestions to improve contraceptive prevalence. Data were analysed with Epi-Info 6.3 and comparisons tested with the chi-square test (significance set at 5%). 63.6% (318 of 500) of the young women and female teenagers lived with a partner; 43.4% discussed some aspects of reproductive health with their parents, especially menstruation and STDs, including AIDS. Although 93.4% of the interviewees knew about condoms and 68.2% about the calendar (rhythm) method, few of them used these (respectively 33.6% and 31.8%). The interviewees decided about contraceptive use with their partners (37%) or alone (28%), and rarely asked their parents (1%). Contraceptives were obtained at a health facility by 3.8% of the subjects, and at the drugstore or market by 20.6%. The main reason for the low rates of use of health facilities (10.4%) and of medical contraceptive methods (11.2% of all contraceptive methods used) were: lack of means, information, and interest (in such facilities and methods), and finally, lack of sexual activity. The condom was essentially the only modern contraceptive method used. The main reason for the low rate of use of reproductive health services may be that apart from the condom, women and female teenagers rarely use modern contraceptive methods. Improving information about reproductive health, creating more "young friendly clinics", and developing peer educators might improve the contraceptive prevalence rate among young women in Togo.

Adolescent↗
PubMedDate not supplied

Effect of oral contraceptive use on the incidence of impaired glucose tolerance and diabetes mellitus.

Combined estrogen-progestin high-dose oral contraceptives increase the risk of impaired glucose tolerance which is estimated at approximately 12% of oral contraceptive current users. Glucose tolerance is adversely affected by the chemical structure of the progestins contained in oral contraceptives such as estrane (norethindrone, ethynodiol) and particularly gonane (norgestrel). The women at high risk to develop an impaired glucose tolerance on high-dose, oral contraceptives are those with previous gestational diabetes, with a positive family history of diabetes mellitus in a first-degree relative, or who are obese or older. Low-dose oral contraceptives with a reduced content of estrogen and progestogen such as levonorgestrel or desogestrel as well as the triphasic oral contraceptives containing a low daily dose of levonorgestrel or gestodene, are associated with a significantly lower risk of impaired glucose tolerance, even in women with previous gestational diabetes. Noteworthy however is the ability of low-dose progestogen containing oral contraceptives, such as low dose gonane or estrane oral contraceptives, to induce glucose intolerance by increasing the plasma insulin response to oral glucose. Impaired glucose tolerance is often reversible within 6 months of discontinuing oral contraceptives, except for oral contraceptive users with previous gestational diabetes. Development of diabetes mellitus in high-dose oral contraceptive users is rare.

Contraceptives, Oral, Combined↗
PubMed1987

Young adults' contraceptive practices: an investigation of influences.

This study investigated young adults' contraceptive behaviors and attitudes through application of a comprehensive, theoretical framework. Specifically, a social-psychological approach to understanding preventive behaviors (e.g., contraceptive practices), was developed, incorporating the Health Belief Model and other factors, which offered a means for evaluating the extent to which contraceptive behaviors were influenced by individual and group characteristics. The study group consisted of 283 unmarried students at several schools who were, on average, 19 years of age. Results suggested that effective contraceptive behavior associated most strongly with respondents' perceiving relatively few barriers to their use of contraception, their maintenance of extensive interpersonal skills, and their regarding peer norms as consistent with effective contraceptive behavior. Findings also underlined a need for continuing education about sexuality and contraception. Dangerous misinformation prevailed regarding respondents' knowledge of areas that include anatomy, physiology, and appropriate use of effective contraceptive methods. Finally, results implied a need to consider broad behavioral, social, and interpersonal issues as they relate to young adults' effective contraceptive behavior. Future studies of contraceptive risk taking are encouraged to examine both individual and social factors affecting sexual and contraceptive practices if unplanned pregnancy is to be minimized, if not eliminated.

Adolescent↗
PubMed1985

Hospitalizations among black women using contraceptives.

We analyzed hospitalizations among 26,507 young black women who attended a large metropolitan family planning clinic between 1968 and 1976. Age-adjusted hospitalization rates were compared for women using oral contraceptives, intrauterine contraceptive devices, and depot medroxyprogesterone acetate. Overall, intrauterine contraceptive device and depot medroxyprogesterone acetate users were hospitalized at about the same rate, while women using oral contraceptives were hospitalized 30% less often. The oral contraceptive users were not hospitalized at a higher rate for circulatory disease. Compared to women using intrauterine contraceptive devices, users of oral contraceptives and depot medroxyprogesterone acetate were less likely to be hospitalized for benign breast disease (rate ratios = 0.5 and 0.2, respectively, with 95% confidence limits of 0.3 to 0.7 and 0.1 to 0.5) and for pelvic inflammatory disease. Women were four times as likely to be using depot medroxyprogesterone acetate when they were hospitalized with carcinoma in situ of the cervix, but depot medroxyprogesterone acetate users with at least 3 years of use were less likely to be hospitalized for carcinoma in situ than comparable groups of oral contraceptive and intrauterine contraceptive device users.

Adolescent↗
PubMed1993

Emergency contraception.

The term 'emergency contraception', as employed in this paper, refers to methods that are used as emergency procedures to prevent pregnancy following unprotected intercourse. Alternative, less appropriate, terms are postcoital and 'morning-after' contraception. References to postcoital preparations can be found as far back as 1500 BC in Egyptian papyri, but it was not until fairly recently that contraceptive research has been able to at least partially fulfill that need. The development of hormonal methods of emergency contraception goes back to the 1960s when the first human trials of postcoitally administered high-dose oestrogens were undertaken. Combined oestrogen- progestogen combination therapy (the so-called Yuzpe regimen) was introduced in the early 1970s, while the postcoital insertion of an intrauterine contraceptive device (IUD) for emergency contraception was first reported in 1976. Other compounds that have been tested more recently include levonorgestrel, the antiprogestogen mifepristone, and danazol. Although there is some debate about the magnitude of the protective effect, few people question the important role that emergency contraception can play in preventing unwanted pregnancy and hence maternal mortality and morbidity resulting from unsafe abortion. Given that the most often used methods of emergency contraception, namely the Yuzpe regimen and postcoital insertion of an IUD, rely on technology that has been available for some 30 years, family planning programmes that claim to be concerned with improving women's reproductive health, cannot really be excused if they do not provide emergency contraception as part of their routine services.

Contraception↗
PubMed1984

Barrier contraception.

Barrier contraception is a safe, effective, reversible form of contraception acceptable to many couples. The use of barrier contraception may protect against carcinoma of the cervix and sexually transmitted diseases. Distribution and education in the use of barrier contraception does not always require medical supervision. This must make it an attractive form of contraception for agencies supporting family planning programmes in developing countries. The only marketed recent advance in barrier contraception is the collatex sponge. Effectiveness rates range between 9 and 27 pregnancies per 100 woman-years. This is unlikely to make it the first choice of contraception for couples who would find an unintended pregnancy a severe problem, but the sponge will be acceptable to couples who are simply trying to delay a pregnancy. The new surge of interest in barrier contraception could lead to safer more effective forms of contraception being made available to women without medical supervision. This would have many advantages, but could also detract from the ability of family planning clinics to play an important role in preventative medicine for women.

Adrenergic beta-Antagonists↗
PubMed1995

Oral contraceptives and breast cancer risk among younger women.

BACKGROUND: Several studies have suggested a link between oral contraceptive use and breast cancer in younger women, but it is possible that chance or bias, including selective screening of contraceptive users, contributed to the putative association. PURPOSE: Given that oral contraceptives were first marketed in the United States in the early 1960s, we conducted a population-based case-control study to examine the relationship between use of oral contraceptives and breast cancer among women in a recently assembled cohort, focusing on women younger than 45 years of age who had the opportunity for exposure throughout their entire reproductive years. METHODS: Breast cancer patients and healthy control subjects were identified, the latter group by random-digit dialing, in Atlanta, Ga., Seattle/Puget Sound, Wash., and central New Jersey. In Seattle and New Jersey, the study was confined to women 20 through 44 years of age; in Atlanta the age range was extended through 54 years. Patients included women with in situ or invasive breast cancer newly diagnosed during the period of May 1, 1990, through December 31, 1992. In-person interviews were completed by 2203 (86.4%) of 2551 eligible patients and 2009 (78.1%) of 2571 eligible control subjects. Analyses focused on women younger than 45 years of age (1648 patients and 1505 control subjects) to maximize opportunities for extended exposure. Logistic regression analyses were used to obtain maximum likelihood estimates of relative risks (RRs) and their 95% confidence intervals (CIs). RESULTS: Among women younger than 45 years, oral contraceptive use for 6 months or longer was associated with an RR for breast cancer of 1.3 (95% CI = 1.1-1.5). Risks were enhanced for breast cancers occurring prior to age 35 years (RR = 1.7; 95% CI = 1.2-2.6), with the RR rising to 2.2 (95% CI = 1.2-4.1) for users of 10 or more years. The RR for breast cancer for those whose oral contraceptive use began early (before age 18 years) and continued long-term (> 10 years) was even higher (RR = 3.1; 95% CI = 1.4-6.7). The RRs observed for those who used oral contraceptives within 5 years of cancer diagnosis were higher than for those who had not, with the effect most marked for women younger than age 35 years (RR = 2.0; 95% CI = 1.3-3.1). Oral contraceptive associations were also strongest for cancers diagnosed at advanced stages. Evaluation of screening histories and methods of diagnosis failed to support the speculation that associations could be due to selective screening. Among women 45 years of age and older, no associations of risk with use of oral contraceptives were noted. CONCLUSIONS: The relationship between oral contraceptives and breast cancer in young women appears to have a biologic basis rather than to be an artifact or the result of bias.

Adult↗
PubMed1991

Effects of low and high dose oral contraceptives on blood coagulation and thrombogenesis induced by vascular subendothelium exposed to flowing human blood.

We investigated the effect of oral contraceptives with low and high estrogen concentration on blood coagulation and thrombogenesis, induced by vascular subendothelium of rabbit aorta exposed to flowing human blood. Twenty healthy women intending to take oral contraceptives were studied [1] before drug ingestion (control), and subsequently during the intake of oral contraceptives with [2] low estrogen content (20 micrograms ethinyl estradiol and 150 micrograms desogestrel per day) and [3] high estrogen content (50 micrograms ethinyl estradiol and 125 micrograms desogestrel per day). All experiments were performed between day 17 and 21 of the menstrual cycle and drug effects were studied during the third tablet cycle. Deposition of fibrin, platelets and platelet thrombi on vascular subendothelium was tested at a defined blood flow and wall shear rate (10 ml/min, 650 s-1) and was quantified by morphometrical techniques. Treatment with the low and high dose contraceptive increased the plasma levels of ethinyl estradiol (728 +/- 139 and 1438 +/- 212 vs. 0 fmol/l [low and high dose vs. control], means +/- SEM, P less than 0.001) and fibrinogen (2.3 +/- 0.1 and 2.6 +/- 0.1 vs. 2.0 +/- 0.1 g/l, P less than 0.05); and decreased antithrombin III activity (95 +/- 3 and 92 +/- 3 vs. 101 +/- 3 %, P less than 0.05). Fibrin deposition on vascular subendothelium was enhanced by the high dose contraceptive only (47 +/- 4 vs. 35 +/- 4 % coverage of the subendothelial surface with fibrin, high dose vs. control, P less than 0.05). The subendothelial deposition of platelets and platelet thrombi was not changed by contraceptive treatment. These results indicate that treatment with high dose contraceptives leads to an increase of fibrin-subendothelial interactions, whereas low dose contraceptives do not significantly alter the blood-subendothelium interactions. observed in this ex vivo model of thrombogenesis.

Adolescent↗
PubMed1995

Multicenter trial of two monophasic oral contraceptives containing 30 mcg ethinylestradiol and either desogestrel or gestodene in Thai women.

The efficacy and acceptability of two third generation oral contraceptives in Thai women were evaluated in a prospective, open, group-comparative, randomized, multicenter trial of women asking for contraception. In six Family Planning Centers and Outpatient Gynaecological Clinics in urban areas in Thailand, 783 healthy women who were at risk for pregnancy and did not have contraindications to oral contraceptive use were randomly allocated to one of the two study groups. An oral contraceptive containing 30 mcg ethinylestradiol and 150 mcg desogestrel was given to 394 women and an oral contraceptive with the same amount of ethinylestradiol and 75 mcg gestodene to 389 women during 6 cycles. Criteria of cycle control, side effects and the presence and severity of acne vulgaris were assessed and blood pressure and body weight measured at pretreatment and after cycles 1, 3 and 6. Furthermore, the efficacy was evaluated after the last cycle. No pregnancies occurred with either of the contraceptives. The incidences of irregular bleeding and minor side effects in both groups were very low and decreased after an initial increase in the first cycle. Acne improved in both groups. Blood pressure and body weight remained unchanged. The two oral contraceptives were found to be effective and acceptable in Thai women. Compared to Caucasian women, the incidences of irregular bleeding and side effects were apparently lower in these Asian women. Furthermore, the effects of both oral contraceptives were comparable.

Adult↗
PubMed1994

Haemostasis profile in smoking and nonsmoking women taking low-dose oral contraceptives.

The effects of oral contraceptives on coagulation in 258 nonsmoking and in 190 smoking women were determined. In smokers and in nonsmokers taking oral contraceptives, fibrinogen and fibrinopeptide A concentrations were higher than in oral contraceptive nonusers. In nonsmokers, oral contraceptives increased antithrombin III activity. The effects on coagulation of oral contraceptives with a different ethinylestradiol content (from 35 mcg to 20 mcg) were then evaluated in 333 of these women. The biggest changes in coagulation were observed in smokers taking the preparation with the highest estrogen content. Reduction of the ethinylestradiol dose caused a decrease of the changes in coagulation induced by oral contraceptives both in smokers and nonsmokers. These results might suggest that during oral contraception the coagulation system is affected mainly in smokers and that the decrease of the estrogen dose might lower the effects of the association of smoking and oral contraception on coagulation.

Adolescent↗