A multicentre study of coagulation and haemostatic variables during oral contraception: variations with four formulations

Article Abstract:

Oral contraceptives (OC) containing estrogen and progestogens (such as progesterone) are known to increase the risk of thrombo-embolic diseases, such as excessive blood clot formation and the possibility that clots will move throughout the body and critically impair circulation. To learn more about the nature of these effects, the World Health Organization carried out a randomized, controlled study of women from four diverse ethnic groups in four locations: Salvador, Brazil; Santiago, Chile; Singapore; and Dublin, Ireland. Subjects included 622 women between the ages of 18 and 35 who chose OC as their method of contraception and 155 women who did not use OC. At the initial clinic visit, and during the 3rd, 6th, and 12th treatment cycles, blood was sampled to measure 12 variables related to clotting. Subjects were randomly assigned to receive one of four common OC preparations: norethisterone acetate (NEA) at 1 milligram plus ethinyl estradiol (EE) at 50 micrograms; levonorgestrel (LNG) at 250 micrograms plus EE at 50 micrograms; LNG 250 at micrograms plus EE at 30 micrograms; and LNG at 150 micrograms plus EE at 30 micrograms. Results showed significant changes from baseline values in 10 coagulation- or clotting-related variables (prothrombin time, factor VIIC, fibrinogen, platelet count, factor X, antithrombin III, fibrinolysis, plasminogen, alpha2-antiplasmin) in at least one OC group. These changes did not take place in the subjects who were not using OC. The changes noted were in the procoagulation (clot-promoting) direction. All four drug regimens were associated with a reduced prothrombin time, an increased factor X activity, and increased fibrinogen. Preparations containing LNG did not affect certain variables as much as did those with NEA. The lowest doses of LNG and EE were associated with fewer adverse effects. However, the effects of these OCs on clotting and coagulation variables are not desirable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Physiological aspects, World Health Organization, Coagulation

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Primary ovarian twin pregnancy: case report

Article Abstract:

A pregnancy that implants and grows in areas outside of the uterus is called an ectopic pregnancy. A case is presented of a 27-year-old woman who developed severe abdominal pain and fainting sensations. Her last menstrual period was seven weeks earlier but she had experienced some painless bleeding two weeks prior to the hospital admission. The woman, who had high blood pressure, was taking oral birth control pills which contained progesterone only, since the combined pill which contains both progesterone and estrogen is not recommended for women with high blood pressure. Blood pressure decreased to a dangerously low level indicating blood loss. A diagnosis was made of ectopic pregnancy that had ruptured and bled into the abdomen. Surgery revealed a blood cyst in the right ovary that was removed. The removed ovary contained two small twin embryos measuring eight and nine millimeters in length. Ectopic twin pregnancies are extremely rare. The only four cases reported in England were removed from women in their thirties who had previously given birth. This is the first reported case of a woman on the progesterone-only birth control pill developing a twin ectopic pregnancy. The case contrasts with the other reported cases in that the patient was in her twenties, had never been pregnant before, and did not have endometriosis, a condition predisposing women to ectopic pregnancies. Some researchers have reported that the progesterone-only birth control pill increases a women's chances for an ectopic pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Pregnancy, Ectopic, Ectopic pregnancy

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Oral contraceptive steroids and breast secretions

Article Abstract:

Birth control pills (oral contraceptives), composed of steroid hormones, have been associated with breast disease and breast cancer. To determine the effect hormones from oral contraceptives have on breast secretions, fluid from the breasts of 164 non-pregnant non-menopausal women was obtained from a study group of 368 healthy women. Oral contraceptive users had less breast fluid secretion when compared with women who did not use the pill. Findings on the women who had a history of childbirth revealed that women who had never used oral contraceptives had a 94 percent rate of breast secretion compared to 51 percent of current pill users and 60 percent of the women who had a history of pill use. Thirty percent of the women who never had children had breast secretions, and among this group, the rate was not effected by the use of oral contraceptives. It is suggested that hormones present in birth control pills effect breast function and that the breasts of women who have and who have not given birth respond differently to these hormones.

Health aspects, Lactation, Steroid hormones, Breast

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