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PubMed1988

Oral contraceptives and breast cancer: what has 20 years of research shown?

This article reviews 20 years of research to determine if oral contraceptive usage increases the risk of breast cancer. Studies using animal models, epidemiology, and human tissues are presented. Results suggest oral contraceptives do not initiate breast cancer, but may act as tumor promoters, stimulating the growth of already transformed cells. The answers are not all in, and the need for continued research is emphasized.

Animals↗

PubMed2006

Lactation and risk of endometrial cancer in Japan: a case-control study.

The incidence of endometrial cancer is rapidly increasing in Japan. Although the risk factors in European populations have been well described, there are few epidemiologic studies regarding risk factors for endometrial cancer in Japanese women. This hospital-based case-control study among Japanese women was carried out from 1998 to 2000. The cases were selected from women with endometrial cancer (n =155), and the controls selected from women attending the university gynecological outpatient clinic for cervical cancer screening (n = 96). Subjects were interviewed to ascertain breast feeding practices, contraceptive usage, as well as potential risk factors for endometrial cancer. We observed a lower risk of endometrial cancer associated with oral contraceptive (OC) and a higher risk associated with higher body mass index (BMI), and older ages at first and last delivery. Gravidity reduced odds ratio (OR) for endometrial cancer to 0.34 (95% confidence interval [CI] 0.13-0.92). Compared with parous women who had never breastfed, the multivariate OR for women with a history of breastfeeding was 0.37 (95% CI, 0.17-0.82). Additionally, a greater lapse of time since breastfeeding increased OR for endometrial cancer by over three times. In conclusion, the present study has indicated that breastfeeding reduces the risk of endometrial cancer in Japanese women.

Adult↗

PubMed1987

Anti-oestrogen antibodies in users of oral contraceptives and in patients with systemic lupus erythematosus.

Recent studies have demonstrated that many patients with SLE have elevated plasma levels of the minor oestrogen metabolite 16 alpha-hydroxyestrone (16 alpha OHE). This oestrogen is unique in its ability to react with lysine residues and form stable, covalent Heyns products with proteins. Increased levels of 16 alpha OHE-modified proteins have been found to occur on the membranes of red cells and lymphocytes in patients with SLE. In the present study, patient and control sera were analysed for the presence of circulating immunoglobulins which react with an oestrogen hapten. Anti-oestrogen antibodies were detected in 26% (9/34) of male and female SLE patients, and were found to correlate both with levels of plasma 16 alpha OHE (P less than 0.001) and with the presence of active disease (P less than 0.005). Surprisingly, this antibody activity was also observed in 25% (13/52) of normal, disease-free women who had a history of oral contraceptive use. No detectable activity was observed in normal men, women who had not taken oral contraceptives, or patients with a variety of other immunological diseases. The possible role of anti-oestrogen antibodies in both the hormonal exacerbation of SLE and in the long-term sequelae of oral contraceptive usage is discussed.

Adult↗

PubMed1988

Risks and mechanisms of cardiovascular events in users of oral contraceptives.

Three large British studies on the vascular effects of oral contraceptives have established that the risk of thromboembolic episodes, both venous and arterial, rises with increasing estrogen dose. Two of these studies have also demonstrated a dose-dependent relationship between the progestogenic component of oral contraceptives and the risk of arterial disease, though not of venous events. In men, high levels of factor VII coagulant activity, VIIC, and plasma fibrinogen are associated with an increased risk for ischemic heart disease. In view of the dose-dependent relationship between estrogen and these two clotting factors, especially VIIC, it is likely that the effects of oral contraceptive usage on the risk for thromboembolism are mediated substantially through the level of coagulability. The relationship between the progestogenic component of oral contraceptives and the risk for arterial disease is probably related, at least in part, to the effects of progestogens on blood pressure.

Antigens↗

PubMed2000

Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations.

The prospect of a hormonal male contraceptive is no longer distant. Data on the potential impact of this improvement in contraceptive provision, however, is limited, particularly between different cultures. We have therefore carried out a multi-centre study to assess men's attitudes to proposed novel hormonal methods. Questionnaire-based structured interviews were administered to men in Edinburgh, Cape Town, Shanghai and Hong Kong. Approximately 450 men were interviewed in Edinburgh, Shanghai and Hong Kong, and a slightly larger group (n = 493) in Cape Town to give samples (n > 150) of black, coloured and white men. Knowledge of existing male and female methods of contraception was high in all centres and groups. The majority of men welcomed a new hormonal method of contraception, 44-83% stating that they would use a male contraceptive pill. Overall, a pill was more acceptable than an injectable form (most popularly given at 3-6 month intervals); long-acting implants were least so except in Shanghai. Familiarity with comparable female methods appeared to influence acceptability, for both oral and injectable methods. Hong Kong was the only centre where a male method (condom) was currently the most commonly used; men there appeared to rate the convenience of condoms highly while being least likely to think that they provided effective protection against pregnancy compared to other centres, and were least enthusiastic about novel male methods. The acceptability of potential male hormonal methods of contraception was high in some groups but showed wide variability, determining factors including cultural background and current contraceptive usage. These results suggest that the emerging emphasis that men should have greater involvement in family planning will be substantiated when appropriate contraceptive methods become available.

Adolescent↗

PubMed2000

Modern combined oral contraceptives for pain associated with endometriosis.

BACKGROUND: Endometriosis is a major women's health-care problem. It causes pain and/or infertility, and affects millions of women worldwide. Endometriosis is defined according to histological criteria by the presence of tissue resembling endometrium in sites outside the uterus, most commonly the ovaries and peritoneum. The aim of treatment has been to remove the deposits of ectopic endometrium that are thought to be responsible for the symptoms of endometriosis. This can be achieved surgically by destroying or removing the implants; medical therapies induce atrophy within the hormonally-dependent ectopic endometrium. The duration of hormonal treatment may be limited by unwanted side effects. There is some evidence, however, from epidemiological research that current use of the combined oral contraceptive pill (OCP) is associated with a reduced incidence of endometriosis. The combined pill has the great advantage over other hormonal treatments that it can be taken indefinitely. OBJECTIVES: The aim of this review was to establish the role of modern oral contraceptives in the management of painful symptoms ascribed to endometriosis. SEARCH STRATEGY: The search strategy of the Menstrual Disorders Group was utilised to identify all randomised trials of the use of oral contraceptives in the treatment of symptomatic endometriosis. In addition a search of the Cochrane Controlled Trials Register was undertaken together with approaches to pharmaceutical companies. SELECTION CRITERIA: All truly randomised controlled trials of the use of oral contraceptive pills in the treatment of women of reproductive age with symptoms ascribed to the diagnosis of endometriosis made visually at a surgical procedure, were included. DATA COLLECTION AND ANALYSIS: Study quality assessment and data extraction was carried out independently by two reviewers. One of the assessors was an expert in the content matter. MAIN RESULTS: Only one study was identified which satisfied the inclusion criteria. The oral contraceptive used in a conventional manner was less effective than a GnRH analogue in the relief of dysmenorrhoea. No significant difference was noted between the effectiveness of the oral contraceptive pill and a GnRH analogue in the relief of dyspareunia or non-menstrual pain. Headaches and weight gain were more commonly associated with oral contraceptive usage than with GnRH analogue usage whereas hot flushes, insomnia and vaginal dryness were less common. REVIEWER'S CONCLUSIONS: There is a paucity of data relating to the use of oral contraceptive preparations in the treatment of symptomtic endometriosis. The data such as it is supports the common practice of the use of the oral contraceptive pill as a first line therapy but further research is required to fully evaluate its role in the management of endometriosis.

Contraceptives, Oral↗

PubMed2001

Reasons why women have induced abortions in a developing country.

OBJECTIVE: The immediate explanation that women often give for seeking induced abortion is that the pregnancy was unplanned or unwanted. However, the myriad social, economic and health circumstances that underlie such explanations have not yet been fully explored. We wanted to evaluate these factors that lead one to have an abortion. STUDY DESIGN: This prospective study was performed on 588 women applied to our family planning unit to obtain an abortion. Analysis is based on the records of the women's age, educational level, their contraceptive usage and the reasons that they give for having an abortion. We also examined how these reasons were related to women's age, educational attainment and contraceptive choices. RESULTS: The desire to postpone a birth or to stop childbearing is a very common reason given by the women seeking abortion. It is seen that despite the women's desire to postpone or stop childbearing, the majority of them were not using an effective contraceptive method. Women's age is closely related to their reasons for seeking an abortion. On the other hand, we have found no clear association between women's educational level and their main reasons for seeking an abortion. CONCLUSION: Reasons women give for why they seek abortion are often far more complex than simply not intending to become pregnant. While improved contraceptive use can help reduce the unintended pregnancy and abortion, some abortions will remain difficult to prevent, because of limits to women's ability to determine and control all circumstances of their lives.

Abortion, Induced↗

PubMed1983

Effects of sex education on sexual guilt, anxiety, and attitudes: a comparison of instruction formats.

Previous sex education research has neglected to examine systematically the effects of different types of instruction formats. In the present study, 193 undergraduates were assigned to one of the following conditions: (1) lecture only; (2) small group discussion only; (3) lecture + small group discussion; (4) lecture + extra lecture/review; and (5) no intervention control. Pre- and posttest measures assessed the dimensions of sexual guilt, sexual attitudes, and sexual anxiety. Results revealed significantly greater reductions in sexual guilt for the lecture only, lecture + small group discussion, and lecture + extra lecture/review conditions than for the no intervention control condition. Significantly greater changes in the direction of more tolerant sexual attitudes were found for the small group discussion only and lecture + extra lecture/review conditions than for the no intervention control condition. No other significant results were found. Contrary to expectation, the addition of 9 hours of small group discussion to a semester-long lecture format course did not result in significantly greater positive changes on the dimensions assessed than those achieved by lecture alone. The implications of these findings for the design of sex education courses are discussed. Recommendations for future research include assessment of the long-term effects of sex education on dimensions such as quality of sexual adjustment and consistency of contraceptive usage.

Adaptation, Psychological↗

PubMed2005

Contraceptive prevalence among young women in Nigeria.

In almost all societies in the world there is an increase in sexual activity among young persons (10-24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies. This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years. Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p<0.05) among the single sexually active women (38.5%) than among the married women (7.7%). Only 7.3% of respondents are currently using a contraceptive method. The main methods in use were condoms and pills. There is an unmet need for contraceptives among young women in Nigeria. It is necessary to improve these young women's abilities to protect themselves against unwanted pregnancies.

Adolescent↗

PubMed2006

Contraception after medical abortion.

OBJECTIVES: This study's objectives were to examine current evidence on contraception after abortion and to formulate guidelines for the use of different contraceptives after medical abortion based on current evidence. METHODS: This study was based on review of published literature and guidelines on postabortion use of contraception. RESULTS: Contraception needs to be initiated early following a first-trimester abortion. Postabortion family planning is an integral part of comprehensive abortion care. Concurrent contraception with surgical abortion has been found to be practical and effective, with high contraception usage following abortion. Most methods can be safely used following medical abortion and can be initiated either on the day of misoprostol administration (oral pills, condoms and injectable contraceptives) or after the next menstrual cycle (intrauterine device and sterilization). CONCLUSION: With proper precautions, almost all contraceptive methods can be effectively used following medical abortion.

Abortion, Induced↗

PubMed1986

The mammographic breast pattern and oral contraception.

The relationship of oral contraceptive usage to breast parenchymal patterns has been studied in 5319 self-selected women presenting to a breast screening unit. Among premenopausal women, 46.1% had taken an oral contraceptive ("the pill") in the past, and 9.5% were still taking the pill. These patients showed a decreased incidence of P2 patterns and an increased incidence of N1 patterns. Of the post-menopausal women, 14.7% had been on the pill. Similar differences of incidence of parenchymal patterns are noted in these women. The significance of these changes is unclear.

Adult↗

PubMed1982

Carbohydrate metabolism studies in women using Brevicon, a low-estrogen type of oral contraceptive, for one year.

A prospective study of carbohydrate metabolism was done in 12 normal women over 1 year's time while they were using the low-estrogen type of oral contraceptive Brevicon, which contains 0.035 mg of ethinyl estradiol and 0.5 mg of norethindrone. The women had a 3-hour oral glucose tolerance test before starting the drug and then in 12 months, both blood glucose and plasma insulin levels were measured. After 1 year, there was no significant change in weight, blood pressure, or plasma insulin levels. There was a slight decrease in the fasting blood glucose value after 1 year's use (67.5 +/- 1.5 versus 63.2 +/- 1.3 mg/dl). The other glucose values were unchanged. The importance of these data in terms of mechanisms of action of the steroids on metabolism and the safety of oral contraceptive usage is discussed.

Adolescent↗

PubMed1999

Contraception in teenage Nigerian school girls.

Contraception is reviewed in 314 teenage Nigerian school girls comprising 128 students at secondary and 186 at tertiary levels of institution. Out of all the teenagers, 26.8% were sexually exposed, among whom there was a total pregnancy rate of 19.05%. The rate of sexual exposure was higher in teenagers from tertiary institutions, 38.7% compared with 9.4% from secondary institutions. However, the pregnancy rate was higher among the sexually exposed secondary school girls, 33% vs. 16.7% for tertiary school girls. The mean level of contraceptive awareness for the various methods of contraception was 38.2% for the entire survey group: 22.6% for the secondary school girls and 54.4% for the tertiary school girls. Mean true contraceptive usage (TCU) among sexually active students, on the other hand, was 17.7%: 5% and 16.5% for the secondary school girls and tertiary school girls, respectively. The source of information on contraception for the study group was highest from 'a friend' (37.3%) and from the 'newsprint' (36.9%) and was lowest from routine 'lectures and sex instructions' (9.2%). Twenty-five point five per cent of the entire study group, 43% of the secondary school girls and 13.4% of the tertiary school girls, had never had any information on contraception. Instruction on contraception, as part of the academic curricula at the primary, secondary and tertiary levels of education, would improve contraceptive knowledge and forestall the emotional and social problems resulting from unwanted teenage pregnancies.

Adolescent↗

PubMed1977

Benign breast disease and oral contraceptive use.

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

Adult↗

PubMedDate not supplied

Plasma renin activity, reactivity, concentration and substrate following hypertension during pregnancy. Effect of oral contraceptive agents.

Plasma renin activity is suppressed in approximately 25% of patients with essential hypertension, and the rate of in vitro angiotensin I production after addition of exogenous renin (renin reactivity) is increased in plasma of hypertensive patients. We have recently observed that blood pressure (116 +/- 1.5/68 +/- 1.7 mm Hg) of young women who had hypertension during a first pregnancy 3--6 years earlier (n = 63) was higher (p less than 0.005) than blood pressure (109 +/- 1.4/61 +/- 1.7 mm Hg) of women who remained normotensive during pregnancy (n = 52). To determine if alterations of the renin-angiotensin axis observed in patients with established hypertension also occur in young adults with relatively high blood pressure, plasma renin activity (PRA), plasma renin concentration (PRC), plasma renin substrate (PRS) and plasma renin reactivity (PRR) were compared in these two groups of subjects. Overall, PRA and PRC were inversely related to systolic blood pressure (p less than 0.02). Excluding women on oral contraceptive agents, the PRA response to standardized treadmill exercise was suppressed (less than 1.0 ng/ml/hr) in 19% of women with a history of hypertension during pregnancy and in no women who remained normotensive throughout a previous pregnancy; PRR did not differ (p greater than 0.8) in the two groups of young mothers (27.1 ng/ml/30 min +/- 1.2 SE VS 26.2 ng/ml/30 min +/- 0.9 SE). Thus, renin suppression, but not increased PRR, precedes the onset of hypertension. Oral contraceptive usage was associated with higher systolic blood pressures, increased PRS, and low PRC. Highest blood pressures and lowest PRA occurred in women with a history of hypertension during pregnancy who were taking oral contraceptive agents at the time of study.

Adolescent↗

PubMed1976

Pulmonary hypertension in patients using oral contraceptives. A report of six cases.

Six young women who had taken progestational agents for a period of time ranging from six months to five years developed symptoms and signs of pulmonary hypertension. Cardiac catheterization confirmed the presence of severe pulmonary hypertension without evidence of other cardiac or pulmonary abnormalities to explain this phenomenon. Three of the patients had potential predispositions to pulmonary hypertension, including a corrected patent ductus arteriosus with mild pulmonary hypertension in one, collagen vascular disease in a second, and family history of pulmonary hypertension in a third. Three patients had no known predisposing factors. Although the relationship between oral contraceptives and severe pulmonary hypertension is problematic, there have been isolated reports of cases of pulmonary hypertension secondary to oral contraceptive usage. These cases and the possible pathophysiologic mechanisms responsible are discussed.

Adult↗

PubMed1975

Oral contraceptives and thromboembolism: a reassessment.

The relationship between oral contraceptive usage and thromboembolism is controversial. Since thromboembolism is often undiagnosed, both clinically and at routine autopsy, most epidemiologic analyses rest or a very uncertain factual base. There are increases in blood coagulation factors in oral contraceptive users similar to, but less than, those seen in pregnancy, which is not associated with increased thromboembolism. Hematologists emphasize that these changes do not define a "hypercoagulable" state, and they do not define or predict the occurrence of thrombosis. Intrinsic vascular wall changes, unrelated to drug use, may play a role in sporadic cases of thromboembolism. When the incidence of thromboembolism in very large Phase III trials of conventional oral contraceptives is compared to that in other populations (patients admitted to the hospital, women who visit a physician, pregnant women, or users of nonestrogenic oral contraceptives), no difference is seen. Epidemiologic studies by the "case-control" ("trohoc") method consistently show an increase "relative risk" associated with oral contraceptive use in subjects with "idiopathic" thromboembolism but no increased risk in thromboembolism patients as a whole or in those with predisposing factors. This retrospective epidemiologic technique, its particular applications, and the inferences drawn are open to serious criticism, as are studies claiming a relationship between estrogen dose and thromboembolism incidence. An Australian prospective survey found no increased risk among users, and a large British study which initially reported an increased risk is currently undergoing recalculation. The only controlled clinical experiment (with random assignment of subjects to vaginal versus high-estrogen contraceptives) showed no increased incidence in the drug-treated group. Statistical associations derived from "trohoc" studies do not establish causal relationships; moreover, their risk estimates are in conflict with the findings of large Phase III clinical surveys including subjects using estrogen-free contraceptives, with at least one prospective clinical survey, and with a randomized, controlled clinical trial. The data relating estrogen dosage to thromboembolism incidence are ambiguous, at best. Thus, the claim of a causal relationship between oral contraceptive steroids and thromboembolism does not appear to be firmly founded, and the belief that predisposing factors increase the risk to contraceptive users is equally insubstantial.

Adolescent↗

PubMed1989

Effects of smoking and oral contraception on plasma beta-carotene levels in healthy women.

Oral contraceptive use and smoking have been known to affect plasma vitamin levels. Total carotenoids have been studied with spectrophotometry, a relatively insensitive technique. In this study plasma concentrations of beta-carotene and retinol were measured in coded samples by sensitive high-pressure liquid chromatography in a cross-sectional study of 149 normal healthy women attending a family planning clinic. At the time of recruitment in the morning, a general health questionnaire was administered for patient age, methods of contraception, smoking habits, and food intake at breakfast. Of the 149 enrolled volunteers, 88 were oral contraceptive users and 61 were not users. Among users, 21 smoked cigarettes, and there were 18 smokers among nonusers. Oral contraceptive users had significantly lower plasma concentrations of beta-carotene (p less than 0.001) and higher retinol levels (p less than 0.0001). Plasma beta-carotene or retinol levels did not differ among users of intrauterine contraceptive devices or barrier methods of contraception. No association was noted between the plasma levels of these two micronutrients and age greater than or less than 30 years. Cigarette smoking alone was associated with significantly reduced plasma beta-carotene levels in nonusers (p less than 0.001). Combined cigarette smoking and oral contraceptive usage were associated with low plasma beta-carotene levels; the results appear to be additive. These findings suggest a possible synergistic effect on plasma beta-carotene levels from the use of both cigarette smoking and oral contraception.

Adolescent↗