Administration Of Oral Contraceptives Research Articles

Effect of administration of oral contraceptives on the synthesis and breakdown of myofibrillar proteins in young women

Oral contraceptive (OC) treatment has an inhibiting effect on protein synthesis in tendon and muscle connective tissue. We aimed to investigate whether OC influence myofibrillar protein turnover in young women. OC-users (24±2 years; Lindynette® n=7, Cilest® n=4) and non-OC-users (controls, 24±4 years n=12) performed one-legged kicking exercise. The next day, the myofibrillar protein fractional synthesis rate (FSR) was measured using stable isotopic tracers ((13)C-proline) while the subjects were fed standardized nutrient drinks. Simultaneously, a marker for myofibrillar protein breakdown, 3-methyl-histidine (3-MH), was measured in the interstitial fluid of the vastus lateralis. Measurements were performed in both legs. In general, myofibrillar protein FSR was lower in OC-users (two-way analysis of variance, P<0.05), although the difference seemed to depend on the OC type. Interstitial 3-MH in the skeletal muscle was not different between groups and did not vary by OC type. Exercise did not change myofibrillar protein FSR or 3-MH concentrations. Serum androstenedione and bioavailability of testosterone were lower in OC-users. In conclusion, the results indicate that the use of OC has an inhibiting effect on myofibrillar protein synthesis and the magnitude of the effect may depend on the type of OC. In contrast, there was no effect of OC on myofibrillar protein breakdown in the fed state.

Salivary Cortisone Is a Potential Biomarker for Serum Free Cortisol

Salivary cortisol measurement is used as a practical surrogate for serum free cortisol. However, parotid tissue harbors 11β-hydroxysteroid dehydrogenase (11β-HSD2) activity converting cortisol to cortisone. This study was designed to assess the impact of parotid 11β-HSD2 activity on the measurement of salivary cortisol. PATIENTS, DESIGN, AND OUTCOME MEASURES: Study participants with changes in circulating corticosteroid-binding globulin (CBG) (±oral contraceptive, functionally CBG null) and controls were studied during adrenal stimulation by ACTH and postoral and iv hydrocortisone administration. Simultaneous serum and saliva samples were collected for the measurement of total serum cortisol (SerF) by immunoassay, and unbound cortisol and cortisone in serum (FreeF and FreeE) and saliva (SalF and SalE) by liquid chromatography-tandem mass spectrometry. ACTH stimulation increased SerF, FreeF, SalF, SalE, but not FreeE in all individuals. SerF significantly decreased after stopping oral contraceptive administration, but FreeF, SalF and SalE remained unchanged. In the hydrocortisone administration study, individual FreeF and SalE curves were nearly identical and SalE closely reflected FreeF in all participants, irrespective of CBG changes. The highest correlation in all (n = 537) matched serum-saliva samples was between SalE and FreeF (r = 0.95, P < 0.0001), and there was no evidence of 11β-HSD2 saturation. Salivary cortisol is a useful surrogate for circulating free cortisol, but its concentration is determined both by serum free cortisol and parotid metabolism to cortisone. We have shown that salivary cortisone closely reflects free serum cortisol after adrenal stimulation and hydrocortisone administration and is unaffected by CBG changes. Salivary cortisone has potential as a useful surrogate for serum free cortisol in research and clinical assessment, and further research in states of chronic glucocorticoid excess is now needed.

Sessile polyps and pedunculated polyps respond differently to oral contraceptives

Endometrial polyp is the lesion frequently found by hysteroscopy. The presence of endometrial polyp is associated with abnormal uterine bleeding and is probably associated with infertility. Until today, clinical guidelines for endometrial polyp remain elusive. The aim of this preliminary study was to estimate whether the shape of endometrial polyps affects the response to the treatment with an oral contraceptive (OC). We performed a retrospective case series study on 50 women diagnosed as endometrial polyps by hysteroscopy and managed by the administration of OC. Hysteroscopy was performed in the follicular phase of the menstrual cycle before medical treatment. Endometrial polyps were classified as pedunculated polyps (n = 25) or sessile polyps (n = 25). After diagnosis, OC was administered for 2–5 months (median 3 months) intermittently: To quantify the regression rate of lesions, the area index of endometrial polyps was assessed. In the study group, when comparing the efficacy of treatment with OC, there was a statistically significant difference in the regression rate between sessile polyps and pedunculated polyps (76% vs. 44%, p = 0.042). We conclude that sessile polyps are more sensitive to OC treatment than pedunculated polyps, implying usefulness of the hysteroscopic classification of the shape of polyps in the management of endometrial polyps.

High-calcium diet reduces blood pressure, blood volume and preserves vasorelaxation in oral contraceptive-treated female rats

Cardiovascular complications are the major clinical challenges among users of synthetic steroids in oral contraceptive (OC) formulations. Interventions that reduce blood volume and improve vasorelaxation have been shown to reduce hypertension and the associated risk factors. The aim of the present study was to investigate the influence of increasing dietary calcium from 0.9 to 3.0% on the development of OC-induced high blood pressure and associated changes in female Sprague-Dawley rats treated with a combination of OC steroids (1 μg ethinyl estradiol and 10 μg norgestrel; p.o.) daily for 10 weeks. Results showed that OC administration led to significant increases in blood pressure, blood volume and cardiac weight. Conversely, OC caused significant reductions in body weight, urinary excretion of water, plasma levels of calcium, 17β-estradiol and progesterone. Increased dietary calcium attenuated the elevation in blood pressure induced by OC and abrogated the associated changes in blood volume, cardiac weight, plasma calcium and urinary excretion of water. The endothelium-dependent relaxation responses to acetylcholine and endothelium-independent relaxation responses to sodium nitroprusside in noradrenaline-precontracted aortic rings were not significantly different among the groups. The results indicate that increased calcium intake abrogated the development of high blood pressure and associated increased blood volume and cardiac weight during OC treatment. The beneficial effect of increased dietary calcium during OC use may be explained by improved diuretic and preserved vasorelaxant responses.

The use of oral contraceptives as a prevention of recurrent premenstrual psychosis

Premenstrual psychosis is a rare and not formally recognized disorder (DSM-IVR, ICD-10). The literature mainly consists of clinical cases. There have been preliminary reports of improvement in such cases after administration of oral contraceptives. We present a case of premenstrual psychosis in which hormonal treatment was effective in preventing symptomatic relapses.

Behcet’s disease: remission of patient symptoms after oral contraceptive therapy

We report a patient with Behcet's disease (BD) who went into remission after administration of oral contraceptives. About 2 years after the diagnosis of BD, she developed dysfunctional uterine bleeding with menometrorrhagia, during which oral and genital ulcers and erythema nodosum-like lesions persisted without remission. The oral contraceptive that was prescribed to control her irregular menstruation also suppressed outbreaks of ulcers and erythema nodosum-like lesions. This case suggests that sex hormones might be considered as one of the aggravating or inducing factors in BD.

Oral contraceptive administration attenuates endothelium-dependent relaxation in response to histamine but not to acetylcholine in aortic rings of female rats

The incidence of vascular disorders is markedly lower in cycling, pre-menopausal women and post-menopausal women receiving estrogen-progestogen therapy than in men or untreated postmenopausal women. Clinical studies demonstrate that estrogen-progestogen therapy in pre-menopausal women is associated with increased arterial vascular risk. However, the mechanism of estrogen-progestogen therapy in arterial vascular complications remain unclear. Therefore, the present study aimed at investigating whether chronic administration of combined oral contraceptive (OC) containing progestogen with androgenic property alters endothelium-dependent relaxation responses of the aorta to histamine and acetylcholine. The experiments have been studied on aortic rings obtained from vehicle-treated and OC-treated female Sprague-Dawley rats. Isometric reactivity of aortic rings was recorded with a strain gauge transducer. The maximum contractile response of the aortic rings to noradrenaline in the OC-treated group was not significantly different from that in the vehicle-treated group. Both acetylcholine and histamine caused relaxation of the noradrenaline pre-contracted aortic rings. The relaxation response to acetylcholine in rings from vehicle-treated and OC-treated rats did not differ significantly, while relaxation response to histamine was significantly attenuated in aortic rings from OC-treated rats. In conclusion, the results from the present study suggest that the increased arterial vascular risk associated with OC administration might involve altered endothelium-dependent relaxation via histaminergic-mediated mechanism, but not via muscarinergic-mediated mechanism.

Oral Contraceptive-Associated Thromboembolism. A Retrospective Analysis of Thrombophilic Work-out and Long Term Follow up in 57 Cases

Introduction: The increased risk of venous thrombosis in women taking oral contraceptives (OCs) has been recognized since the early 1960s. Coexistence of hereditary risk factors appears to have an additive effect. Women under OCs that carry the factor V Leiden mutation have a 35-fold increased risk of thromboembolic events compared to women without the mutation who are not on OCs. Evaluation of family and personal history is the mainstay of prophylaxis prior to OC administration, but often family thrombophilia or thromboembolic (TE) events are not reported prior to OCs prescription.Patients-Methods: Fifty-seven women with a median age of 28 (21–48) years, which suffered OC-associated TE, were studied. The median period of OC therapy prior to TE event was 2 months (0.5–60). Fifty-five of them experienced VTE while 2 suffered stroke. Leg thrombosis was the most common clinical finding [37/55 (67,2%) patients] Apart from personal and family history, Thrombophilia investigation included measurement of : serum Homocysteine, Antithrombin, Protein C and S, Lipoprotein (a), Activated Protein C (APC) resistance, antiphospholipid antibodies and lupus anticoagulant. In addition the presence of FV Leiden, FII 20210 GA mutations and MTHFR 677 CT polymorphism were determined.Results: A high prevalence of the factor V Leiden mutation was detected in the study group; 50% had APC-resistance test positive, 26 (45%) patients were found to be heterozygous and 3 (5,2%) homozygous for the FV Leiden mutation. Lp(a) elevation was observed in 19,3% and Homocysteine elevation in 15,8% of patients. In 9 women (15,8%) both family history and thrombophilic profile were negative. Serious VTE events (2 abdominal and 6 CNS thromboses) were observed only in the Leiden subgroup. During the follow up period ranging from months to 18 years, 3 women (6,25%) experienced a miscarriage and 14 suffered additional VTE events (25%) and they are currently on permanent anticoagulation.Conclusions : Universal thrombophilia screening of women prior to prescription of OCs is not advisable as it does not appear to be cost effective. However, screening certain subgroups, such as women with a known personal or family history, may be of great value. If a full thrombophilic profile can't be performed, a mere activated protein C resistance test, that reflects the presence of the factor V Leiden mutation, may provide an easy and cheap way of identifying and consulting properly women at higher risk for VTE prior to OC use. Women with OC-associated VTE and thrombophilia carry a substantial recurrence risk that persists for years.

Oral contraceptive administration aggravates nitric oxide synthesis inhibition-induced high blood pressure in female rats

The use of estrogen–progestogen oral contraceptive (OC) is associated with high blood pressure, although mechanisms responsible are still unclear. This study sought to investigate the effects of administration of OC on high blood pressure resulting from nitric oxide (NO) synthesis inhibition in female Sprague– Dawley rats. Rats were given ethinyl estradiol in combination with norgestrel and were treated with NO synthase inhibitor, N G-nitro- l-arginine methyl ester ( l-NAME) in the drinking water or drinking water alone for 6 weeks. OC treatment alone led to a significant increase in blood pressure and positive water balance. Treatment with l-NAME alone resulted in a significant elevation of blood pressure without significant positive water balance. Concomitant treatment with OC and l-NAME produced significant increases in blood pressure and water balance. These magnitudes of increases were significantly greater than those observed in rats treated with OC or l-NAME alone. Treatment with OC did not affect NO biosynthesis with or without concurrent l-NAME treatment. Treatment with OC and/or l-NAME did not significantly affect body weight, food intake, heart rate, cardiac weight/body weight ratio, plasma sodium, glomerular filtration rate and urinary sodium output. Conclusion: These data demonstrate that OC administration resulted in a modest increased blood pressure via enhanced water retention that was not associated with impaired NO synthesis. On the other hand, these results showed that increased blood pressure induced by inhibition of NO synthesis was not associated with water retention. The study also indicated that OC administration aggravated increase in blood pressure during NO synthesis inhibition, via enhanced water retention.

Postoperative Long-term Maintenance Therapy with Oral Contraceptives after Gonadotropin-releasing Hormone Analog Treatment in Women with Ovarian Endometrioma

Study Objective The goal of this preliminary study was to assess the effect of cyclic monophasic oral contraceptives (OCs) as a postoperative long-term maintenance therapy (median 33.2 months) to suppress recurrence of endometrioma after conservative ovarian surgery followed by gonadotropin-releasing hormone (GnRH) analog treatment. Design Retrospective clinical study (Canadian Task Force classification II-2). Setting Adolescent and premarital clinic in a university hospital. Patients The study was performed on 51 patients who underwent conservative surgery for endometrioma followed by GnRH analog treatment for 6 months. Interventions We used cyclic monophasic OCs as maintenance therapy after surgical and medical treatment with GnRH analog for 6 months. Measurements and Main Results Cyclic monophasic OCs were offered to young patients (n = 51, age = 24.1 ± 2.8 years) who did not want to conceive immediately, to prevent the recurrence of endometrioma after conservative surgery with 6 cycles of postoperative GnRH analog treatment. During the long-term follow-up period (median 41.2; range 19–94 months), no recurrences of the endometrioma occurred in the current OC users. One patient showed a recurrence of endometrioma at 12 months after the discontinuation of the OCs. The median duration of OC administration was 33.20 months (range 12–86). In addition, 4 of 10 patients became pregnant within 12 months of discontinuing the long-term OC therapy. Conclusion Postoperative long-term maintenance therapy with OCs can effectively suppress endometrioma recurrence in adolescent and young patients.

Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

Women are at greater risk than men for certain kinds of diseases and injuries, which may at least partly be caused by sex hormonal differences. We aimed to test the influence of estradiol in vivo on collagen synthesis in tendon, bone, and muscle. Two groups of young, healthy women similar in age, body composition, and exercise-training status were included. The two groups were either habitual users of oral contraceptives exposed to a high concentration of synthetic estradiol and progestogens (OC, n = 11), or non-OC-users tested in the follicular phase of the menstrual cycle characterized by low concentrations of estradiol and progesterone (control, n = 12). Subjects performed 1 h of one-legged kicking exercise. The next day collagen fractional synthesis rates (FSR) in tendon and muscle connective tissue were measured after a flooding dose of [(13)C]proline followed by biopsies from the patellar tendon and vastus lateralis in both legs. Simultaneously, microdialysis catheters were inserted in vastus lateralis and in front of the patellar tendon for measurement of insulin-like growth factor I (IGF-I) and its binding proteins. Serum NH(2)-terminal propeptide of type I collagen (PINP) and urine COOH-terminal telopeptides of type-I collagen (CTX-I) were measured as markers for bone synthesis and breakdown, respectively. Tendon FSR and PINP were lower in OC compared with control. An increase in muscle collagen FSR postexercise was only observed in control (P < 0.05). Furthermore, the results indicate a lower bioavailability of IGF-I in OC. In conclusion, synthetic female sex hormones administered as OC had an inhibiting effect on collagen synthesis in tendon, bone, and muscle connective tissue, which may be related to a lower bioavailability of IGF-I.

Effects of prior oral contraceptive use and soy isoflavonoids on estrogen-metabolizing cytochrome P450 enzymes

Estrogen exposure and metabolism may play an important role in the development of estrogen-sensitive cancers in postmenopausal women. In this study we investigated whether past oral contraceptive (OC) administration or current dietary isoflavonoids (IF) affected expression and/or activity of steroid hormone-metabolizing cytochrome P450 (CYP) enzymes using complementary primate and cell culture models. One-hundred-eighty-one female cynomolgus macaques were randomized to receive OC or nothing for 26 months premenopausally, then ovariectomized and randomized to one of three diets for 36 months: an IF-depleted soy protein isolate (Soy−) diet, a Soy diet with IF (Soy+), or a Soy− diet supplemented with conjugated equine estrogens (CEE). Prior OC-treatment significantly reduced CYP gene expression in the mammary gland (≤60% of OC-). Dietary IFs had no effect on CYP expression, while CEE-treatment decreased CYP1A1 and increased CYP3A4 mRNA in a tissue-specific manner. For in vitro studies, we measured effects of the isoflavonoids genistein, daidzein and equol on CYP activity using intact V79 cells stably transfected to express CYP1A1, CYP1B1, or CYP3A4. All three IFs significantly altered CYP activity in a dose-dependent and isoform-specific manner (20–95% inhibition versus controls). These results suggest potential mechanisms for prior OC and dietary IF effects on cancer risk in estrogen-responsive tissues.

Reliability of results and interpretation of measures of 3-methylhistidine in muscle interstitium as marker of muscle proteolysis

TO THE EDITOR: We were interested in the contribution by Tesch and colleagues to the evidence base concerning the events subsequent to acute immobilization in human muscle. Tesch and colleagues (14) used a microdialysis technique applied to human muscle in an attempt to measure an index of myofibrillar proteolysis 72 h after immobilization using the unilateral leg suspension technique. The authors discuss their results as though they had good evidence that the technique they used produces results that are sufficiently firm to be the basis of conjecture about mechanisms of protein balance in muscle after immobilization. We demur and propose that they are on very shaky ground. First, we wonder about the size of the effect reported. The authors claim it to be 44%, but calculation of the change shows it to be actually 29% with the SEs sufficiently large that they almost span the difference; SDs must overlap. Significance at the 5% level can only barely have been reached. Are the authors convinced that they have not ignored a type I error? The authors (14) begin their explanation of the advantages of the dialysis technique using 3-methylhistidine (3MeHis) by describing the gold standard method, i.e., the stable isotopelabeled amino acid tracer dilution method, as cumbersome and possibly unjustified in study of otherwise healthy subjects. We find this notion strange since Ferrando and colleagues (6, 12) have used the technique in many studies of how immobilization affects muscle protein turnover subsequent to disuse. We have also used the techniques in a wide variety of studies of proteolysis in healthy and infirm subjects (1, 2, 10, 11, 15) with no problems and, we would propose, producing results with a greater degree of certainty and biological appropriateness than those obtained by the 3MeHis dialysis technique.

Does the pretreatment with oral contraceptive pill during long luteal protocol of leuprolide acetate effect the cycle outcome in ICSI patients

OBJECTIVE: The aim of this study was to compare oral contraceptive (OC) pretreatment in addition to GnRH-analog (GnRHa) long luteal protocol with standard long luteal protocol among normoresponder ICSI patients.DESIGN: Retrospective analysis.MATERIALS AND METHODS: All of the patients used GnRHa long protocol for ICSI and were divided into two groups according to OC administration. Patients in the Group A (n=50) were treated with a standard long protocol of leuprolide acetate initiated on the 21st day of the menstrual cycle, patients in the Group B (n=110) were pretreated with an OC for 21 days starting on the first day of menstruation. The administration of leuprolide acetate was initiated on the 15th day of OC administration until the hCG day. When pituitary suppression was achieved, ovarian hyperstimulation was commenced depending on the patients' individual characteristics.RESULTS: There were no statistically significant differences recorded in the demographic characteristics of patients including age, BMI, day 3 FSH level between groups. However, day 3 E2 level is statistically higher in Group A than Group B (48.54±46.18, 31.7±27.41, p=0.001). No differences were found between the groups in terms of developed ovarian cysts, the mean number of stimulation days, total dose of gonadotropins used, estradiol level and endometrial thickness on the day of hCG administration. Coasting cycles were significantly higher in Group B than Group A (22.5% vs 6.5%, P=0.02, respectively). Despite, in Group A number of mature (M2) oocytes (10.44±4.73 vs 8.84±3.56, P=0.02) were significantly higher than OC pretreated group, number of 2 PN embryos (8.45±9.5 vs 6.75±3.05, P=0.63) were similar between groups. Fertilization rates (76.7%, 67.8%, respectively) and top quality (grade A) embryos (82.1%, 72.1%, respectively) were significantly higher in Group B than Group A (P=0.009, P=0.018). There were no significant differences between groups in regards of implantation (16% vs 21.8%, P=0.497, respectively) and clinical pregnancy rates (32% vs 35.5%, P=0.67, respectively) between groups. Number of the cycles cancelled as a result of poor ovarian response or ovarian hyperstimulation syndrome (OHSS) were similar in both groups.CONCLUSIONS: Pretreatment with OC during long luteal protocol does not improve cycle outcome among normoresponder ICSI patients. OBJECTIVE: The aim of this study was to compare oral contraceptive (OC) pretreatment in addition to GnRH-analog (GnRHa) long luteal protocol with standard long luteal protocol among normoresponder ICSI patients. DESIGN: Retrospective analysis. MATERIALS AND METHODS: All of the patients used GnRHa long protocol for ICSI and were divided into two groups according to OC administration. Patients in the Group A (n=50) were treated with a standard long protocol of leuprolide acetate initiated on the 21st day of the menstrual cycle, patients in the Group B (n=110) were pretreated with an OC for 21 days starting on the first day of menstruation. The administration of leuprolide acetate was initiated on the 15th day of OC administration until the hCG day. When pituitary suppression was achieved, ovarian hyperstimulation was commenced depending on the patients' individual characteristics. RESULTS: There were no statistically significant differences recorded in the demographic characteristics of patients including age, BMI, day 3 FSH level between groups. However, day 3 E2 level is statistically higher in Group A than Group B (48.54±46.18, 31.7±27.41, p=0.001). No differences were found between the groups in terms of developed ovarian cysts, the mean number of stimulation days, total dose of gonadotropins used, estradiol level and endometrial thickness on the day of hCG administration. Coasting cycles were significantly higher in Group B than Group A (22.5% vs 6.5%, P=0.02, respectively). Despite, in Group A number of mature (M2) oocytes (10.44±4.73 vs 8.84±3.56, P=0.02) were significantly higher than OC pretreated group, number of 2 PN embryos (8.45±9.5 vs 6.75±3.05, P=0.63) were similar between groups. Fertilization rates (76.7%, 67.8%, respectively) and top quality (grade A) embryos (82.1%, 72.1%, respectively) were significantly higher in Group B than Group A (P=0.009, P=0.018). There were no significant differences between groups in regards of implantation (16% vs 21.8%, P=0.497, respectively) and clinical pregnancy rates (32% vs 35.5%, P=0.67, respectively) between groups. Number of the cycles cancelled as a result of poor ovarian response or ovarian hyperstimulation syndrome (OHSS) were similar in both groups. CONCLUSIONS: Pretreatment with OC during long luteal protocol does not improve cycle outcome among normoresponder ICSI patients.

Low dietary folate impairs glucose tolerance and plasma lipid profile in oral contraceptive-treated rats

Estrogen–progestogen oral contraceptive (OC) use is associated with abnormal lipid metabolism, impaired glucose tolerance and high prevalence of vascular complications. OC use has been shown to alter the requirements for folic acid. Therefore, the aim of the present study was to clarify the influence of dietary folic acid on OC-induced impaired glucose tolerance and abnormal plasma lipid profile in female Sprague– Dawley rats. Vehicle-treated and OC-treated rats were fed for 6 weeks with a control diet (750 μg folic acid/kg diet) while OC-treated folic acid deficient (FD) rats were fed for 6 weeks with a folic acid-deficient diet (250 μg folic acid/kg diet). OC receiving rats were treated with a combination of OC steroids (ethinyl estradiol and norgestrel) by oral gavage. OC treatment resulted in rats receiving folic acid deficient diet in impaired glucose tolerance, decreased high-density lipoprotein (HDL)-cholesterol and increased low-density lipoprotein (LDL)-cholesterol when compared with control rats. However, OC treatment did not result in impaired glucose tolerance or disturbed plasma lipid profile in rats receiving the same folic acid level as the controls. OC treatment led to significant decreases in plasma levels of 17β-estradiol and testosterone in both groups. OC administration in rats with folic acid deficient diet significantly lower HDL-cholesterol and higher LDL-cholesterol levels while plasma levels of 17β-estradiol and testosterone were similar in both OC-treated groups. Conclusion: These results demonstrate impaired glucose tolerance and disturbed plasma lipid profile induced by OC treatment in folic acid deficient rats and suggest that inadequate folic acid intake might contribute to increased cardiovascular risk during OC use that could be prevented by proper oral folic acid intake.

Emergency Contraception Knowledge, Attitudes, Practices, and Barriers among Providers at a Military Treatment Facility

The safety and efficacy of postcoital administration of oral contraceptives, commonly called "emergency contraception pills" (ECPs), have been well documented; nonetheless, this method of preventing pregnancy is underused in the United States. Through the use of surveys, the current study assessed providers' knowledge, prescribing practices, attitudes, and barriers regarding ECPs at a military treatment facility in the southwest United States. Results showed a lack of knowledge of ECP provision, with 34% believing treatment had to be initiated in 48 or fewer hours, and 60% believing two doses must be taken within 24 hours or more of each other. Slightly more than one- half (54.4%) of the providers reported having prescribed an ECP; those who had prescribed had more positive attitudes about ECPs. Perceived barriers included women not asking for ECPs, concerns about safety of ECPs, and issues regarding liability. A discrepancy between providers' perceived and actual knowledge about ECPs supports the need for better education for all providers who care for women.

Effect of Combined Oral contraceptive Steroids on Plasma Lipids, Lipid Peroxidation and Nitric Oxide Biosynthesis in female Rats

Oral contraceptive (OC) usage is associated with increased cardiovascular risk. The present study investigated the effect of combined OC on plasma lipids, lipid peroxidation, and biosynthesis of nitric oxide (NO). Female Sprague – Dawley rats were treated with OC steroids (10mg/kg ethinyloestradiol + 100mg/kg norgestrel) or drug vehicle for seventy days by gavage. Plasma malondialdehyde (MDA) and urinary NO2/NO3 concentrations were assessed as indicators of lipid peroxidation and biosynthesis of NO respectively. LDL cholesterol/HDL-cholesterol ratio and total cholesterol/HDL-cholesterol ratio were taken as atherogenic markers. Results showed that LDL – Cholesterol, LDL-Cholesterol/HDL-Cholesterol ratio and total cholesterol / HDL-Cholesterol ratio were significantly higher in OC treated rats while OC treatment caused significant decreases in plasma HDL-cholesterol and urinary NO2/NO3 levels. However, no significant differences were observed in plasma MDA, total cholesterol and triglyceride levels between both groups of rats. The results of this study suggest that chronic administration of high-dose OC may increase incidence of atherosclerotic cardiovascular disease, and further provide evidence that OC use is associated with decreased NO biosynthesis, hypercholesterolaemia and unaltered lipid peroxidation. Keywords : Oral Contraception, Cholesterol, lipid peroxidation, nitric oxide NQJHM Vol. 14 (3&4) 2004: pp. 224-226

Effect of Combined Oral Contraceptive Steroids on Plasma Lipid Peroxidation and Nitric Oxide Biosynthesis in Female Rats

Oral contraceptive (OC) usage is associated with increased cardiovascular risk. The present study investigated the effect of combined OC on plasma lipids, lipid peroxidation, and biosynthesis of nitric oxide (NO). Female Sprague-Dawley rats were treated with OC steroids (10mg/kg ethinyloestradiol + 100mg/kg norgestrel) or drug vehicle for seventy days by gavage. Plasma malondialdehyde (MDA) and urinary NO2/NO3 concentrations were assessed as indicators of lipid peroxidation and biosynthesis of NO respectively. LDL-cholesterol/HDL-cholesterol ratio were taken as atherogenic markers. Results showed that LDL-cholesterol LDL-cholesterol/HDL-cholesterol ratio were significantly higher in OC-treated rat while OC treatment caused significant decreases in plasma HDL-cholesterol and urinary NO2/NO3 levels. However, no significant differences were observed in plasma MDA, total cholesterol and triglyceride levels between both groups of rats. The results of this study suggest that chronic administration of high-dose OC may increase incidence of atherosclerotic cardiovascular disease and further provide evidence that OC use is associated with decreased NO biosynthesis, hypercholesterolaemia and unaltered lipid peroxidation. Keywords: oral contraceptive, cholesterol, lipid peroxidation, nitric oxide.NQJHM Vol. 15 (3) 2005: pp. 143-145

Comparison of Total and Salivary Cortisol in a Low-Dose ACTH (Synacthen) Test: Influence of Three-Month Oral Contraceptives Administration to Healthy Women

The objective of this study was to evaluate the influence of low-dose combined oral contraception (COC) on basal and stimulated (1 microg ACTH test) levels of serum and salivary cortisol (F), cortisone and on basal serum cortisol binding globulin (CBG), adrenocorticotropic hormone (ACTH), dehydroepiadrosterone (DHEA) and calculated free cortisol in healthy young women. Three-month administration of COC resulted in 1) significant increase of basal (454.0+/-125.0 to 860.9+/-179.7 nmol/l) and ACTH-stimulated serum cortisol in 30th min (652.3+/-60.5 to 1374.1+/-240.6 nmol/l); 2) no significant change of basal (15.4+/-7.3 to 18.9+/-8.5 nmol/l) and ACTH-stimulated salivary cortisol at the 30th min (32.4+/-8.8 to 32.9+/-9.0 nmol/l); 3) no significant change of basal serum cortisone (38,8+/-7.68 to 45.2+/-24.2 nmol/l) and ACTH-stimulated cortisone at the 30th (34.8+/-10.9 to 47.0+/-35.7 nmol/l); 4) significant increase of basal ACTH (17.2+/-9.0 to 38.2+/-29.4 ng/l), CBG (991.0+/-161.0 to 2332.0+/-428.0 nmol/l), and 5) no significant change of basal DHEA (24.6+/-15.7 to 22.6+/-11.7 micromol/l) and calculated basal value for free cortisol (22.8+/-14.9 to 19.2+/-6.9 nmol/l). In conclusions, higher basal and ACTH-stimulated serum cortisol were found after three-month administration of COC, while basal and stimulated salivary cortisol were not significantly affected. Therefore, salivary cortisol can be used for assessment of adrenal function in women regularly using COC.

Pre-operative oral contraceptives therapy before hysteroscopic surgery

Hysteroscopic procedures are best performed when the endometrium is thin, but it is not always possible to schedule the procedure at the appropriate time. The aim of this study was to describe the endometrial effects of medical pre-treatment with oral contraceptives (OC) and increase the ease and safety of the procedure. Patients underwent pretreatment with lowdose OC beginning on menstrual days 1-3. The surgery was scheduled on days 7-25 of the second cycle of OC administration. Estradiol (E2) and progesterone (P4) on the first and the second cycle of OC administration were statistically similar (p<0.01) . There was unpredictable bleeding in 27% of the patients on the first cycle of OC administration. The endometrium surrounding the lesions of interest was almost always thin and flat, such that the operating conditions were excellent. Pretreatment of the endometrium before surgery with OC has been shown to reduce the thickness and vascularity of the endometrium, decrease the amount of tissue removed, improve visualization, reduce operating time and fluid deficits, and increase the ease and safety of procedure. The basis for the effect is due to OC with minimal doses of E2 and P4, thus causing endometrial atrophy.