Editorial: Outpatient treatment of haemorrhoids.

Abstract

The estrogenic potency of combined oral contraceptives (OC) is discussed. A dose of 30-50 mcg estrogen was recommended once it was learned that the incidence of thromboembolic disease was related to the estrogen content of OCs. The synthetic progestogens in OCs are usually nortestosterone derivatives, many of which are partly metabolized to estrogen when taken orally. It is difficult, however, to determine whether pills with lowered estrogenicity will reduce the incidence of thromboembolic disorders. Norethynodrel has a purely additive effect on the estrogenicity of estrogens, norgestrel is antagonistic, while norethindrone and ethynodiol diacetate have less estrogenic action at high doses and more action at low doses. It is doubtful that the standard measure for estrogenicity in the mouse uterus is applicable to the association of thromboembolic disease and OC use. The only way to resolve the question is by a more complete epidemiological analysis, which requires greater cooperation in the reporting of thrombotic incidents.