Combined Oral Contraceptive Pill Research Articles

Perceived Ineffectiveness of Pharmacological Treatments for Dysmenorrhea.

Background: Dysmenorrhea affects most reproductive-aged women. Common dysmenorrhea treatments vary in their effectiveness across individuals. Little is known about factors associated with perceived treatment ineffectiveness. The objectives of this study were to describe the perceived ineffectiveness of common pharmacological treatments for dysmenorrhea and investigate factors associated with perceived treatment ineffectiveness. Materials and Methods: In this cross-sectional study, 678 women with dysmenorrhea (aged 14-42) provided data on perceived treatment ineffectiveness, dysmenorrhea symptom-based phenotypes, demographics, clinical factors, and psychobehavioral characteristics. We used Fisher's exact tests to compare treatment ineffectiveness across three symptom-based phenotypes. We used logistic regressions to explore associations of phenotype, demographic, clinical, and psychobehavioral correlates of perceived treatment ineffectiveness. Results: Percentages perceiving treatments as ineffective were 29.3%-35.6% nonsteroidal anti-inflammatory drugs, 49.9% acetaminophen, and 39.3% combined oral contraceptive pills (OCPs). Factors associated with perceived ineffectiveness varied across treatments and included symptom-based phenotypes, clinical, and psychobehavioral factors. For ibuprofen and acetaminophen, women with severe (vs. mild) pain phenotype and higher number of chronic pain conditions were more likely to perceive the treatments as ineffective. For OCPs, women with severe pain (vs. mild) phenotype, comorbid gynecological condition, less anxiety, and worse depressive symptoms were more likely to perceive the treatment as ineffective. Conclusion: A significant percentage of women reported ineffectiveness of dysmenorrhea treatments. Phenotypes, clinical, and psychobehavioral factors were associated with treatment ineffectiveness. Future research should test if symptom-based phenotypes are associated with treatment effectiveness in clinical trials and investigate other factors that affect dysmenorrhea treatment effectiveness, so treatments can be tailored to individuals.

Epidemiology and 3‐year outcomes of combined oral contraceptive–associated distal deep vein thrombosis

BackgroundDistal deep vein thrombosis (infrapopliteal DVT without proximal DVT or pulmonary embolism [PE]) generally shares the same triggering risks factors as proximal DVT. In women of childbearing age, a frequent triggering risk factor is the use of combined oral contraceptive (COC) pills. However, data on the epidemiology and long‐term outcomes of COC‐associated distal DVT are lacking. ObjectivesTo assess the epidemiology and long‐term outcomes of COC‐associated distal DVT. MethodsUsing data from the OPTIMEV (Optimisation de l’Interrogatoire dans l’évaluation du risque thrombo‐Embolique Veineux [Optimization of Interrogation in the Assessment of Thromboembolic Venous Risk]) multicenter cohort study of patients with objectively confirmed venous thromboembolism (VTE) enrolled between 2004 and 2006, we assessed in nonpregnant or postpartum women aged ≤ 50 years without cancer or history of VTE (i) proportion of COC‐associated distal DVTs among women with distal DVTs and among women with COC‐associated VTEs (distal DVT, proximal DVT, or PE) and (ii) 3‐year incidence of death, bleeding, and VTE recurrence. ResultsCOC‐associated distal DVTs (n = 54) represented 43.9% of all distal DVTs and 51.9% of COC‐associated VTEs. All but one woman with a COC‐associated distal DVT received therapeutic anticoagulation for a median of 3 months. At 3‐year follow‐up, all women with COC‐associated distal DVTs were alive, and none had bled during anticoagulant treatment or had experienced a DVT or PE recurrence after stopping anticoagulants. Similar results were found in patients with COC‐associated proximal DVT and PE: The VTE recurrence rate was 1.7% per patient‐year (PY) and 0% PY, respectively, and there were no deaths or major bleeds in either group. ConclusionsDistal DVT was the most frequent clinical presentation of COC‐associated VTE and had similarly favorable long‐term outcomes as other COC‐associated VTE.

Advances in contraception research and development.

In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies. Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections.There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods. There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.

Producing bodies at risk in sexual health – an ethnographic comparative analysis between the combined oral contraceptive pill and pre-exposure prophylaxis in Switzerland

ABSTRACT This article demonstrates that ‘bodies at risk’ in sexual health are socially constructed. It does so via a heuristic comparison between two molecular technologies that are central to the promotion of sexual health: the combined oral contraceptive pill (COCP) and pre-exposure prophylaxis (PrEP). Drawing on ethnographic research conducted in two sexual health institutions in the western part of Switzerland, the article presents two main findings. First, it argues that bodies are constructed as being at low or high risk by sexual health professionals (based on health and lifestyle criteria). Second, it shows that access to either the COCP or PrEP is largely based on this former classification. The article also demonstrates that there are ambivalent situations in which sexual health professionals seek compromises between different risks, and pragmatically adapt their medical protocols.

Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome.

Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome.

Potential risk of drug-drug interactions with hormonal contraceptives and antiretrovirals: prevalence in women living with HIV.

BackgroundFamily planning services are vital for women living with HIV (WLH); however, the use of concomitant antiretroviral therapy (ART) and hormonal contraceptives (HCs) may pose challenges due to the risk of potential drug–drug interactions (DDIs). The objectives of this study were to assess ART and HC use among WLH and quantify the frequency of potential DDIs between ART and HCs.MethodsThis was a retrospective, observational, cohort study of WLH aged 18–55 years, prescribed ART, with at least one clinic visit from January 1, 2010 to April 30, 2014. Potential DDIs between HCs and ART were assessed using the University of Liverpool HIV Drug Interactions website (www.hiv-druginteractions.org) and categorized as ‘weak potential interaction,’ ‘potential interaction,’ or ‘do not co-administer.’ResultsOverall, a contraceptive method was reported in 167 (54%) of the 309 women included in the study. Of those using contraception, 73 (43.7%) reported using HCs, which was most frequently a progestin intrauterine device (n=43), progestin injection (n=17), or combination oral contraceptive pills (n=9). Out of a total of 449 ART regimens, a potential DDI was identified in 21 of 115 (18.3%) ART–HC combinations from 19 women using ART and HCs. Atazanavir/ritonavir was the most common potentially interacting ART (10, 47.6%); for HCs, these were combination oral contraceptive pills (16, 76.2%) and progestin implants (2, 9.5%).ConclusionIn this cohort, one-quarter of WLH on ART–HCs had a potential DDI. Future studies should investigate the impact of DDIs on unintended pregnancies, the side effects of DDIs, and the effects of HC DDIs on ART concentrations.

Menstrual suppression in girls with disabilities.

Girls with disabilities and their caregivers are challenged during pubertal transitions, particularly with menses onset. More than 50% of caregivers report concern and anxiety related to menarche, and they have sought health care providers to discuss options. Menstrual suppression planning and education from nurse practitioners (NP) is key to ensure quality of life for these girls and their caregivers. The purpose of this systematic review is to examine and evaluate the state of the science surrounding the use of medical modalities for menstrual suppression in adolescent girls with disabilities. Articles were identified through systematic electronic search of the following databases: CINAHL, Medline, Health Sources: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection, PsycINFO, Cochrane Register of Controlled Trials, and Academic Search Complete. Results indicate that the most common medical modality used for menstrual suppression in girls with disabilities is the combined oral contraceptive pill, but depot medroxyprogesterone acetate and levonorgestrel-releasing intrauterine system have been recommended. Concerns related to menstrual suppression include expressed wishes of the girl and her caregivers, existing comorbid conditions, and risks associated with medical modalities used for suppression. Meaningful conversations about concerns and expectations related to pubertal transitions are essential to ensure smooth transitions. NPs should provide counseling and discuss the variety of interventions available for menstrual suppression, being mindful of the need for comprehensive gynecological care. Additional studies using robust methods, including longitudinal and prospective strategies, are needed to better inform NPs of the goals and desirable outcomes for these girls and their caregivers.

Levonorgestrel vs combined oral contraceptive pills in treatment of female acne and hirsutism.

Combined oral contraception was used in many studies for treatment of acne and hirsutism. However, levonorgestrel (LNG) alone has not been evaluated before. Our objective is to evaluate the efficacy of oral contraceptive (OC) pills containing LNG and ethinyl estradiol (EE) compared with LNG only for the treatment of acne and hirsutism in a randomized, controlled prospective clinical trial. Eighty females (20 with acne, 20 with hirsutism, and 40 healthy females) received LNG + EE or LNG only for 6 months. Assessment of acne by global acne grading system (GAGS) and hirsutism by modified Ferriman-Gallwey scale (MFGS) grading system and serum free testosterone was measured before and 6 months after treatment. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P < .000). In acne patients, after 6 months of treatment with LNG/EE, serum free testosterone, and (GAGS), were significantly decreased compared to LNG only (P < .000). In hirsutism group, after 6 months of treatment with LNG/EE, serum free testosterone and (MFGS), were nonsignificantly decreased compared to LNG only. OCs containing either LNG/EE or LNG seem to be effective and safe treatment for acne and hirsutism.

Evaluation of Oxidative Stress Markers’ Status in Obese Females Using Hormonal Contraceptives

Objective: To evaluate the variation in oxidative stress markers including superoxide dismutase (SOD), catalase and malondialdehyde (MDA) and to correlate it with obesity in females using contraceptives.Methodology: Comparative cross sectional study was project of University of Lahore (UOL).conducted in collaboration with Basic Health Unit Mudkey (periphery of Kasur) from January to December 2013. The study population comprised of 51 married females of age ranged 25 to 40 years. The study was approved by the Research Ethical Committee of UOL. Thirty one females using either combined oral contraceptive pills (COC) or progestin injections were enrolled for a period of 9 months, while 20 females not using any type of contraceptives were recruited as a control group. Weight in kg and height in meter were estimated by the standard protocol. Body Mass Index (BMI) was calculated by the formula; weight in kg /height in m2. Subjects having BMI greater than 25kg/m2 were categorized as obese. Stress markers were estimated from blood samples. SOD was assayed by nitroblue tetrazolium method by spectrophotometer. Catalase and Glutathione levels were also determined using spectrophotometer. MDA levels were measured by Thiobarbitoric acid assay reaction. with MDA. Statistical analysis was performed by SPSS20. Mean ± SD (standard deviation) was used for continuous variables; while frequency and percentages were used for estimation of categorical variables. Regression analysis was applied to elucidate association between obesity and the stress markers.Results: SOD and MDA levels were significantly higher in obese group as compared to non-obese group (p values = 0.02, 0.04). No significant differences was noted in obese and non- obese subjects with respect to catalase (p value= 0.35) and Glutathione (p value=0.9) concentrations. Regression analysis shows significant positive association of BMI with SOD (p value 0.006) and MDA (p value 0.000); however, catalase (p value 0.28) and Glutathione (p value 0.85) were not significantly associated with BMI.Conclusion: Oxidative stress in obese are due to higher MDA levels. SOD is positively associated with BMI; however catalase and glutathione are not affected by BMI.

The effects on ovarian activity of delaying versus immediately restarting combined oral contraception after missing three pills and taking ulipristal acetate 30 mg

ObjectiveAmong combined oral contraception (COC) users, to determine the effect on ovarian activity and ovulation of waiting five days before restarting COC, versus restarting immediately, having taken ulipristal acetate 30 mg (UPA, the dose used for emergency contraception) after missing three consecutive COC pills. Study designWomen already using COC were enrolled for two cycles of COC use (21/7 regimen). In cycle 2, all women omitted COC pills for three consecutive days (days 5,6,7), and on day 8 took UPA 30 mg. They were randomized either to restart their COC pills that same day (immediate restart) or to wait five days (delayed restart). Transvaginal ultrasound, and blood sampling for estradiol and progesterone were undertaken on days 4,8,11,13,15,18,22 and 26. A modified Hoogland score was used to quantify ovarian activity/ovulation and to assess whether luteal phase progesterone concentrations were sufficiently ‘adequate’ to have conferred a theoretical risk of pregnancy. ResultsNo one ovulated with risk of pregnancy during the five days following UPA. Among 26 women with immediate restart, none ovulated with a theoretical risk of pregnancy at any time in the cycle. Four of 23 women (17.4% CI [5.0; 38.8]) with delayed restart ovulated with theoretical risk of pregnancy before the end of the cycle. This difference was statistically significant (p = 0.042). ConclusionWomen who delay restarting COC for five days after taking UPA 30 mg are at much greater risk of ovulation, and therefore theoretically of pregnancy, than if they restart their COC on the same day as taking UPA. Current recommendations should be revisited. ImplicationsWomen who take UPA-EC after having missed combined oral contraceptive pills are advised to wait five days before restarting the COC. This delay puts them at risk of ovulation and, if intercourse occurs, theoretically therefore of pregnancy. Women who restart their COC pills immediately are much less likely to ovulate. The label for UPA-EC and clinical guidelines on using EC after missed pills should be revisited.

Gynecologic Management of Adolescents and Young Women With Seizure Disorders: ACOG Committee Opinion, Number 806.

Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.

Gynecologic Management of Adolescents and Young Women With Seizure Disorders: ACOG Committee Opinion Summary, Number 806.

Seizure disorders frequently are diagnosed and managed during adolescence; therefore, obstetrician-gynecologists who care for adolescents should be familiar with epilepsy and other seizure disorders, as well as antiepileptic drugs. Patients diagnosed with seizure disorders during childhood may have increased seizure activity with puberty and menarche due to the neuroactive properties of endogenous steroid hormones. Compared with patients without epilepsy, patients with epilepsy are more likely to experience anovulatory cycles, irregular menstrual bleeding, and amenorrhea. Although hormonal suppression should not be initiated before puberty or menarche, prepubertal counseling may be appropriate, and obstetrician-gynecologists may work with young patients and their families to develop a plan to initiate with menarche. Additionally, obstetrician-gynecologists should be aware of any medication changes, including antiepileptics, for adolescent patients with seizure disorders. Research on hormonal therapy for the treatment of epilepsy is scant; however, the anticonvulsant properties of various progestins have been explored as potential treatment. There is no conclusive evidence that combination hormonal contraception increases epileptic seizures, and epilepsy itself poses no increased risk of an adverse outcome for those using combined oral contraceptive pills, the contraceptive patch, or a contraceptive ring. Because many antiepileptic drugs are teratogenic, discussing sexual health with and providing effective contraceptive choices to this population is critical. Obstetrician-gynecologists should work with patients with seizure disorders to develop a plan when pregnancy occurs.

Fundamental Frequency Variations Across the Menstrual Cycle and the Use of an Oral Contraceptive Pill.

Purpose Concentrations of sex steroid hormones-estrogens, progesterone, and testosterone-have been associated with premenstrual and menstrual vocal symptoms. However, the extent to which these symptoms may be reflected on acoustical features of the voice is still debated. This study investigates variations in fundamental frequency (f o) and related parameters in connected speech across phases of the menstrual cycle and during the use of a combined oral contraceptive pill (OCP). Method Electrolaryngographic recordings were made, and blood samples were collected at three different phases of the menstrual cycle-menstrual, follicular, and luteal-for placebo and OCP use. These two conditions were blindly and randomly allocated in the study. Speaking f o (SFF), SFF standard deviation, SFF rate of change, SFF slope, maximum and minimum f o, and f o range were extracted for nine healthy females while reading a phrase from the Rainbow Passage. Concentrations of sex hormones were analyzed in serum. Nonparametric statistical tests were carried out to assess differences between phases and conditions. Results SFF, its standard deviation, and maximum f o were significantly different between phases of the menstrual cycle for placebo use only. Menstrual phase showed the lowest values. Maximum and minimum f o were significantly different between placebo and OCP use for menstrual and follicular phases, respectively. Conclusions Fluctuations in sex steroid hormones across the menstrual cycle alter f o in speech more than a particular hormonal concentration. OCP use seems to have a stabilizing effect on the voice relative to f o and related parameters in speech.

Anti-fertility potential of Trigonella foenum-graecum in comparison to oral contraceptive pills

Introduction: This study examines the anti-fertility effects of Trigonella foenum-graecum (fenugreek) seeds extract in the reproductive system of female rats in comparison to combined oral contraceptive pills (COCPs). Methods: Thirty two female Sprague Dawley rats of 8 weeks old were divided into four groups (A, B, C and D). All female rats were allowed to mate with male rats. Group A is a positive control and not given any treatment. Group B is a negative control group. Group C and D were treated with 0.05 mg/kg body weight of COCPs and 750 mg/kg body weight of fenugreek seed aqueous (FSA) extract for 15 days respectively. Blood samples were subsequently taken on the proestrous phase to evaluate the serum levels of follicular stimulating hormone (FSH). The embryo implantation rate was studied in all groups. Results: Administration of 750 mg/kg FSA extract and COCPs both resulted in decreased FSH serum levels, to 25.62 ng/ml and 71.56 ng/ml respectively (p&lt;0.01). The embryo implantation rate was zero in both FSA extract and COCPs treated groups. Conclusions: Anti-fertility effects of FSA extract and COCPs are potentially similar in terms of their ability to reduce FSH serum levels and inhibit implantation.

Histological changes of uterus after comparative treatment of female rats by Trigonella foenum-graecum seeds and combined oral contraceptive pills

Introduction: This study evaluates the histological changes of uterine tissue in the female Sprague Dawley rats after administration of Trigonella foenum-graecum (fenugreek) seeds in comparison to combined oral contraceptive pills (COCPs). Methods: Twenty four female Sprague Dawley strain rats of 8 weeks old were divided into A, B, and C groups. Group A was the control and B was administrated with 0.05 mg/kg body weight of COCPs for 15 days. Group C was treated with 750 mg/kg body weight of fenugreek seed aqueous (FSA) extract for 15 days. The uterine tissues were isolated and studied histologically. Results: The uterine weight in the FSA extract treated group was normal, while in the COCPs treated group it was insignificantly increased. The endometrial thickness and endometrial gland density were normal in the FSA extract treated group, while in the COCPs treated group it was atrophied. Decidual-like cells were observed in the COCPs treated group only. Conclusions: Endometrial atrophy and decidual-like cells were noted after COCPs treatment while in the FSA extract and control groups they were absent. The findings suggest that fenugreek seeds could be used as an alternative natural and safe contraceptive product.

Prevalence of confirmed antiphospholipid syndrome in 18‐50 years unselected patients with first unprovoked venous thromboembolism

BackgroundAntiphospholipid syndrome (APS) is an acquired thrombophilia disorder with prevalence not completely known in patients with first unprovoked venous thromboembolic events (VTE). Recent data suggest that the management of some APS patients should be different from that of patients with other thrombophilia. Our aim was to estimate the prevalence of APS in a community‐based cohort of patients with a first unprovoked VTE. MethodsWe conducted a cross‐sectional study analyzing data from our computer assisted oral anticoagulant dosage program. Data of all consecutive patients aged 18 to 50 years who were seen between January 1, 2002 and December 31, 2011 for a first proximal unprovoked VTE were extracted. The prevalence and main features of patients who fulfilled the Sapporo revised criteria for APS were collected. Results and DiscussionA total of 524 incident patients aged 18 to 50 years were included in the anticoagulation clinic during the study period. Of them, 491 were tested for APS and 44 (9.0%; 95% confidence interval [CI]: 6.7‐11.8) fulfilled APS criteria. Of 26 APS women, 8 (30.8%) were on combined oral contraceptive pill at the time of VTE, versus 108 (55.1%) in non‐APS women (P = .02). No difference was observed between APS and non‐APS patients in terms of gender or type of VTE. The prevalence of APS is high in young patients with a first unprovoked VTE. In the direct oral anticoagulant era, when and how to test for APS is challenging and deserves further investigation.

Medicine: before COVID-19, and after

Medicine: before COVID-19, and after

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

BackgroundDiagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS.MethodsInternational healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations.ResultsThis paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years post-menarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an ‘at risk’ label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial.ConclusionsExtensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.

Ormeloxifene versus oral contraceptive pills in the management of DUB

Background: DUB is defined as abnormal uterine bleeding without any clinically detectable pelvic pathology. The present study was conducted to compare the efficacy and safety of ormeloxifene and combined oral contraceptive pills in medical management of DUB. Methods: 110 cases of DUB aged between 25 and 45 years were randomly assigned into two groups. Group A received Ormeloxifene 60mg twice a week for 3 months and then once a week for next 3 months. Group B received combined oral contraceptive pills (Levonorgestrel 0.15mg and Ethinylestradiol 20mcg) one tablet from the 5th day of menses for 21 days given for 6 cycles. Regular follow up was done to assess response, compliance and side effects of drug. The treatment was evaluated by measuring menstrual blood loss by PBAC (Pictoral Blood Loss Assessment Chart), Haemoglobin g/dl and endometrial thickness before and after treatment. Results: Ormeloxifene was found to be significantly more effective (P< 0.0001) than OC pills in controlling menorrhagia. There was significant decrease in endometrial thickness and improvement in Haemoglobin level in ormeloxifene group. Conclusion: Ormeloxifene is more effective and well tolerated than OC pills in treatment of DUB.

Homocysteine Levels in Patients with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome in Ibadan

Introduction: Homocysteine is produced from the conversion of methionine to cysteine. Conditions resulting in hyper homocysteinemia leads to an increased risk of both arterial and venous thromboembolisms by about 2 fold. 20% of HIV infected patients with objective evidence of venous thromboembolism are found to be thrombophilic with higher homocysteine levels. We enquired into homocysteine levels prior to the development of a clinical evidence of a venous thrombus in both HAART naïve and those on HAART of HIV /AIDS population. We evaluated the association between homocysteine, CD4 lymphocyte count and ART use in order to identify possible risk factors for hyper homocysteinemia in HIV population.&#x0D; Method: Employing a cross sectional design; we compared mean plasma levels of homocysteine, full blood count parameters and CD4+ lymphocytes counts in HIV positive patients and HIV negative controls. One hundred and twenty patients with HIV infection attending the APIN clinic at the University College Hospital Ibadan and St Mary’s Catholic Hospital Eleta Ibadan and one hundred and twenty-six HIV negative healthy controls were compared in the study.&#x0D; Results: Fifty-nine point one percent of the HIV positive patient had hyperhomocysteinemia i.e. homocysteine levels of &gt;18µmol/l. The mean plasma homocysteine levels were significantly higher at 24.4µmol/l (SD=13.8) (CI -2 to -8; p=0.002) in the HIV positive group compared with 19.5µmol/L (SD=10.6) in the control group. The use of Anti-retroviral drugs was not associated with higher homocysteine level in the seropositive group and neither were factors like age, gender or the use of combined oral contraceptive pills. There was no correlation between CD4 cell count and homocysteine levels (r= -0.01; p=0.9).&#x0D; Conclusion: Homocysteine levels are elevated in HIV positive patients and hyperhomocysteinemia was found in a significant number of HIV positive patients. None of the patients investigated had features of thromboembolism or outright deep venous thrombosis. Neither CD4 cell counts nor traditional risk factors were associated with the higher homocysteine levels.