Side Effects Of Oral Contraceptives Research Articles

Putting a finger on potential predictors of oral contraceptive side effects: 2D:4D and middle-phalangeal hair

Many women experience emotional or physical side effects when taking oral contraceptives (OCs). Despite the potential impact on women's health and well-being, there are no valid methods to screen women for their risk of OC side effects. The present paper presents the results of two studies where anthropometric indicators of androgen exposure, 2D:4D and middle-phalangeal hair, were examined for their potential as predictors of OC side effects. In study 1, 2D:4D was associated with women's reports of a history of: (a) negative mood side effects; (b) discontinuation due to negative mood side effects; (c) specific mood side effects (i.e., crying, sadness, and altered trust in one's partners) and (d) specific physical side effects (i.e., headaches, fatigue, and decreased sex drive). In study 2, 2D:4D and/or middle-phalangeal hair was/were associated with a reported history of: (a) discontinuation due to negative mood side effects; (b) specific mood-related side effects (i.e., negative mood, disrupted sleep, increased aggression, and altered trust in one's partner) and (c) specific physical side effects (i.e., headaches, decreased menstrual cramps, and increased sex drive/arousal). The general pattern was that adverse OC side effects were experienced by women with lower 2D:4D and fewer middle-phalangeal hairs. Almost all relationships remained significant when response bias was controlled. These results suggest a possible role for prenatal testosterone exposure and both androgen action and sensitivity in women's experience of OC side effects. Furthermore, these two digit measures may be useful predictors of hormonal contraceptive side effects in women.

Oral contraceptives: side effects and depression in adolescent girls

Objective The study was undertaken to determine the side effects, including depression, of oral contraceptives (OCs) in adolescent girls. Methods We conducted a randomized trial of OCs for dysmenorrhea, which assessed side effects and depression. Seventy-six adolescents received an OC (20 μg of ethinyl estradiol/100 mg of levonorgestrel) or a placebo in a double-blind fashion for 3 months. We ascertained OC side effects using open-ended and closed question formats. Participants self-administered the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depressive symptoms. Results Fifty-seven participants (77%) reported at least one side effect (median=2, range=0–8, interquartile range=1.0–3.25). The number and the type of side effects reported in the OC group and in the placebo group were similar. Mean exit CES-D scores were comparable between groups [OC group, 14.0 (SD=9.2); placebo group, 14.4 (SD=8.1); p=.86]. Conclusion Adolescents treated with an OC or a placebo experienced similar numbers and types of OC side effects, as well as depressive symptoms.

What women believe about oral contraceptives and the effect of counseling

Objectives To evaluate Canadian women' s knowledge of the risks, benefits and side effects of oral contraceptives (OCs) and the effect of counseling. Study design Six-hundred and forty-nine Canadian women filling an OC prescription at Shopper's Drug Mart stores completed the survey. Respondents recorded whether or not they had discussed 12 separate issues about OC use with their healthcare provider. Optimal responses to multiple-choice questions were compared between those reporting counseling to those reporting no counseling, using Fisher's Exact Tests. Women were also questioned on what they were told about associated cancer risks. Results Eighty percent or more of the women selected the optimal response for the questions relating to dysmenorrhea, leg pain and co-medication. Less than half of survey respondents identified the optimal response for nausea, breakthrough bleeding, breast tenderness, acne, headaches and weight change. Counseling made a significant impact on selection of the optimal response for 7 of the 12 questions (p < 0.004, adjusted significance level). Fifty-two percent indicated that they did not know what they were told about the risk of uterine and ovarian cancer when on the pill. A significant proportion of women said they would phone their physician for relatively minor problems such as breakthrough bleeding (65%), breast tenderness (55%) and acne (54%). Conclusions The knowledge level of Canadian women on the pill regarding risks, benefits and side effects of the pill remains deficient in several key areas. Adequate counseling by healthcare providers can help women recognize the pill's positive health benefits, and may result in fewer unnecessary physician contacts and unwanted pregnancies.

How low can you get?

Since the early 1960s the side effects of oral contraceptives have been known to be related to the high doses (50 micro g) of ethinyl estradiol used. Research has focused on reducing the dose of both the estrogen and progestin components to reduce these side effects. While reducing the dose of both components, the contraceptive efficacy has to be maintained so as to retain a satisfactory Pearl index. These requirements appear to have been attained with 24-day regimen of a low-dose pill (15 microg of ethinyl estradiol and 60 microg of gestedone) as one part of an open-label noncomparative multicenter study. This paper reports our unit's results, which indicate that the low-dose pill promises to reduce contraceptive-related side effects, to encourage better compliance, and as corollary, to retain a satisfactory Pearl index.

Continuous combined oral contraceptives: results of a randomized controlled trial.

Objective: Administration of continuous combined estrogen/progestin oral contraceptives (OC) has the potential to improve contraceptive efficacy while eliminating the inconvenience of menstruation and minimizing the development or progression of certain gynecologic disorders. The purpose of this pilot study was to compare patient acceptability and side effects of OC administered in an intermittent versus continuous fashion.

Neuroactive steroids and central nervous system disorders

Steroid hormones are vital for the cell life and affect a number of neuroendocrine and behavioral functions. In contrast to their endocrine actions, certain steroids have been shown to rapidly alter brain excitability and to produce behavioral effects within seconds to minutes. In this article we direct attention to this issue of neuroactive steroids by outlining several aspects of current interest in the field of steroid research. Recent advances in the neurobiology of neuroactive are described along with the impact of advances on drug design for central nervous system (CNS) disorders provoked by neuroactive steriods. The theme was selected in association with the clinical aspects and therapeutical potentials of the neuroactive steroids in CNS disorders. A wide range of topics relating to the neuroactive steroids are outlined, including steroid concentrations in the brain, premenstrual syndrome, estrogen and Alzheimer's disease, side effects of oral contraceptives, mental disorder in menopause, hormone replacement therapy, Catamenial epilepsy, and neuractive steroids in epilepsy treatment.

A clinician's response to the oral contraceptive thrombosis controversy.

The controversy involving new progestin oral contraceptives (OC) began in late 1995, continued through 1996, and started to reach resolution in 1997. The fundamental question is whether OC containing desogestrel and gestodene have a different risk of thrombosis compared with OC containing older progestins. Correcting for preferential prescribing and the healthy user effect leads to the conclusion that all low-dose OC--regardless of progestin type--have an increased risk of venous thromboembolism. Low-dose OC do not increase the risk of myocardial infarction or stroke in healthy, non-smoking women less than 35 years of age. With effective patient screening for risk factors, the serious side effects of OC can be virtually eliminated.

Contraceptive strategies for young women in the 21st century

Safe, effective and affordable contraceptives have been available for a few decades, yet, in many countries, the struggle for reproductive rights continues. Children, still, are forced to give birth to children in many nations. In most industrialized countries, where contraceptive counselling and abortions have been options, fertility rates have reached all time lows. Effective contraception improves health and well-being as well and may be used for conditions other than birth control. Young girls often initially take oral contraceptives primarily to reduce menstrual pain and blood loss; they also welcome a contraceptive that eliminates menstrual bleeding. Women using oral contraceptives and Norplant® experience about 50% reduction in menstrual blood; 90% reduction in blood loss is achieved with the levonorgestrel intrauterine system (Mirena®).Teenagers and their parents are often misinformed about the side-effects of oral contraceptives and birth control in general, which may adversely affect compliance. Adequate, user-friendly and supportive information about contraception is necessary to ensure proper use of the pill and other birth control methods. In addition, emergency contraceptives should be easily accessible. The mortality and morbidity of young women would be dramatically reduced by the global use of medical abortion as well. Only a combined effort by policy makers, educators, parents and health-care providers can enhance the reproductive (and future!) health of both young females and males.

Uniqueness of oral contraceptive progestins

Concern about the androgenic side effects of oral contraceptives (OC) has motivated ongoing reformulation of the progestin component, leading to the development of several new synthetic progestins. The increased potency of these steroids has made it possible to reduce the progestin dose substantially.

Oral contraceptive practice guidelines

Introduction Oral contraceptives (OC) are currently being used by 65 million women worldwide, approximately 6% of all women of reproductive age.1 One-fourth of all women of reproductive age in the United States use OCs, which are now more widely used in the United States than any other method, including sterilization.2 Their widespread use throughout the world for several decades suggests that both medical professionals and the lay public believe that the benefits of OCs outweigh potential side effects.1 Greater awareness of the metabolic effects of OCs and the role of smoking and hypertension in the development of cardiovascular disease has led to more selective prescribing and a substantial reformulation of the steroidal components.3 A variety of formulations are available, but all combination OCs contain two components: an estrogen, which maintains the endometrium and prevents breakthrough bleeding, and a progestin with sufficient activity to suppress pituitary gonadotropin secretion. Each of the steroids also has additional functions. The progestin component causes changes in the cervical mucus and the endometrium that enhance the antifertility effects of OCs should ovulation occur4 and the estrogen acts synergistically with the progestin to inhibit the pituitary.4 Since OCs were first introduced, both hormonal components have been substantially reduced in amount and reformulated. Prior to 1992, OCs in the United States contained one of two estrogens, either ethinyl estradiol (EE) or mestranol. Since then, all low-dose OCs (ie, preparations containing ,50 mg) have contained EE exclusively. Low-dose formulations are now the standard, accounting for almost all OC prescriptions. Prior to 1992, OCs in the United States contained one of four progestins: norethindrone; norgestrel and its active isomer, levonorgestrel; norethindrone acetate; or ethynodiol diacetate. All of these mediumand high-androgenic progestins were less selective than later formulations, and they were associated with a variety of adverse androgenic effects. They had a negative effect on carbohydrate and lipid metabolism3,5 and often produced acne,6 hirsutism,7 and weight gain.8,9 In 1992, low-androgenic progestins, norgestimate and desogestrel, were introduced in the United States. Because the affinity of these progestins for progesterone receptors is higher than for androgen receptors, their activity is more selective. Consequently, androgenic side effects associated with OCs containing these progestins are less common compared with the side effects of OCs containing high doses of the more androgenic progestins.10–14 All currently available OCs are highly effective for preventing pregnancy, but variations in their hormonal components are clinically important. Variations in progestin formulations, for example, modulate the overall metabolic and clinical effect of a given combination OC.3 Variations in estrogen dose among formulations containing ,50 mg EE may also affect cycle control. However, all low-estrogen dose formulations are safe for use by nonsmoking women without major cardiovascular risk factors such as uncontrolled hypertension. To assist clinicians in selecting the most appropriate OC for their patients, a panel of experts in gynecology and contraception has developed a set of practice guidelines for OC selection. These physicians, who are members of the editorial board of Dialogues in Contraception, reviewed the guidelines with a panel of 70 visiting faculty members.15,16 Together, they reviewed the clinical effects of the variations in OC formulations on safety, cycle control, side effects, and noncontraceptive benefits—the factors which, collectively, provide the basis for selecting one OC over another for a particular patient. (It must be recognized that these guidelines were developed within the context of countries with advanced medical systems and low maternal mortalities. In less developed countries, with high rates of maternal morality and limited health care resources, the use of any form of oral contraceptive with limited screening and follow-up may be quite appropriate.) Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts; and Department of Obstetrics and Gynecology, University of Tennessee at Memphis, Memphis, Tennessee Name and address for correspondence: Ronald T. Burkman, Chairman, Department of Obstetrics and Gynecology, Baystate Medical Center, 765 Chestnut St., Springfield, MA 01109

Oral contraceptives and thrombosis.

Recent studies have identified an increased risk of venous thromboembolism associated with use of third-generation oral contraceptives (OCs). Use of these newer formulations has been estimated to cause an excess of 10 deaths/year in the UK. The possibility has been raised, however, that prescribing bias and confounding by duration of OC use and other personal risk factors accounts for the difference in the risk of venous thromboembolism between second- and third-generation OCs. Other studies have identified an increased risk of myocardial infarction and stroke in OC users, including users of low-dose formulations, but this risk is almost exclusively limited to older women who smoke or have other cardiovascular risk factors. The interpretation of all such studies on OC side effects should take into account that the absolute risk of an adverse thrombotic event while taking OCs is small. This risk appears to be affected far more by factors such as smoking, age, hypertension, and familial disorders than the type of progestagen contained in the OC.

Hospitalization of young women after selected cardiovascular and thromboembolic incidents in Austria 1993 and 1994

The aim of this study is to describe the hospitalization and regional distribution of selected cardiovascular and thrombo-embolic events (cardiac infarction, cerebral strokes, deep vein thromboses, pulmonary embolism) of young women in Austria in the years 1993 and 1994, and to collect basic epidemiologic data for the study of the side effects of oral contraceptives. The calculated hospitalization rates are based on the Austrian hospitals' discharge records of 1993 and 1994. The persons concerned are women aged between 15 and 44 who live in Austria. The results of the study reveal that--in 1993--of the above mentioned group 51 out of 100,000 inhabitants were hospitalized because of the selected cardiovascular and thromboembolic events: 4/100,000 had a cardiac infarction, 5/100,000 had a stroke, 17/100,000 had a pulmonary embolism, and 27/100,000 suffered a deep vein thrombosis. In 1994 the counted cases per 100,000 inhabitants were 48, out of which 4/100,000 where cardiac infarcts, 5/100,000 strokes, 16/100,000 pulmonary embolism, and 25/100,000 deep vein thromboses.

Effect of vitamin B 6 on the side effects of a low-dose combined oral contraceptive

Analogous to recommendations for treatment of side effects of early pregnancy and premenstrual syndrome, use of vitamin B 6 has been recommended for the treatment of side effects of oral contraceptive (OC) use. A randomized, triple-blinded controlled trial of 124 women was done to evaluate the effect of taking 150 mg of vitamin B 6 daily for 30 days on the severity of nausea, headache, vomiting, dizziness, depression, and irritability associated with the initiation of low-dose (30 μg norgestrel and 30 μg ethinyl estradiol) OC use. The severity of the symptoms was measured on a scale from 0 to 3 (not present to severe), and was evaluated at one month after admission. The two treatment groups (vitamin B 6 and placebo) had comparable baseline characteristics. From admission to follow-up, there was a decrease in the severity of all symptoms in both groups. There was no statistically significant difference in the reductions found in the vitamin B 6 and the placebo groups, although reductions in the severity of headache and dizziness were greater in the B 6 group. The decrease in the severity of all OC side effects can be explained more by a placebo effect than by a marginal pharmacological effect of the vitamin B 6.

Interval and postabortal contraception with the frameless GyneFix

Intrauterine contraceptive devices (IUDs) have not suffered from the same negative influences in the developing world as in the first world. The method has too many basic advantages to be gainsaid including, most importantly, that it has the lowest lifetime cost of any effective method of contraception, and that user compliance is not an issue once the device is in place.However, the global community is not immune from trends that are seen in selected industrialized countries. Today, better methods of contraception are requested and the discomforts associated with earlier models of IUD, which were once acceptable, are less so today. Faced with the side-effects of oral contraception and the high cost in developing countries, many women who have completed their families undergo surgical sterilization as the only long-term method available to them, notwithstanding severe cultural and economic reservations about doing so.The development of the frameless device is a response to the growing need to develop high-performing, long-acting, reversible and acceptable contraceptives with a high continuation of use and to respond to the urgent need to reverse the legacy of neglect of immediate postabortal family planning.

Oestrogens and Psychological Well-being

The last decade has seen increased interest in the role of hormones, including oestrogens, not only in regulating growth, sexual development and reproduction but in maintaining a sense of psychological well-being. Episodes of change in oestrogen levels, whether increasing or decreasing, are high-risk periods for the emergence of psychological symptoms in some women. This may be due to a ‘kindling effect’ for women with previous psychological disturbance, an effect on circadian rhythm activity and therefore altered neurovegetative functions, or an effect on central rhythmic functioning between the hypothalamus and the cerebral cortex, all mediated by effects on neurotransmitter systems. Data supporting these hypotheses come from animal studies as well as converging research in several areas including the study of psychological side-effects of oral contraceptives, the study of mood and cognitive disturbances related to the menstrual cycle, the studies of states of hormonal change such as pregnancy and the menopause and, of course, studies of women with psychiatric disorders such as major depression, seasonal affective disorder and dementia. Improvement in such symptoms via hormonal therapies or other interventions will probably lead to better quality of life for women and may actually impede the deterioration associated with ageing and certain medical illnesses. Current data support a relationship between oestrogen and psychological well-being.

Hormonal Implant Is More Effective Among Teenagers than Oral Contraceptives

Of 130 adolescents age 17 years or under who gave birth at the University of Pennsylvania Hospital between September 1991 and July 1992 48 accepted Norplant at the family planning clinic 2 weeks postpartum and 50 accepted oral contraceptives (OCs). 42 users of each type completed follow-up interviews in April 1993. The participants were predominantly unmarried Black poor and living in a single-parent household. The Norplant acceptors were significantly more likely to be older to have been pregnant 2 or more times to have given birth at least twice before to have experience with contraceptives to have previously used OCs and to have kept their first postpartum appointment. These young women chose implants because of difficulty in remembering to take OCs fear of pregnancy ease of use the side effects of OCs and encouragement from others. Those who choose OCs cited fear of needles and/or insertion concern about side effects and fear that the implant would be visible. Life-table analysis showed 6-month discontinuation rates of 0% for implant users and 45% for OC users. Only 2 women discontinued the implant. During the first year postpartum 19 OC users became pregnant as did 1 implant acceptor (shortly after removal) for a risk of 38% for OCs and 2% for implants. Logistic regression analysis revealed that the only factor which predicted method continuation was choosing Norplant and the only factor which predicted pregnancy was choosing OCs. No differences were found in the incidence of sexually transmitted diseases frequency of intercourse or use of condoms. However condom use was poor overall indicating a need to focus attention on decreasing high-risk behavior.

Oral contraceptive use among African American adolescents: individual and community influences.

Side effects of oral contraceptives are a noteworthy problem, particularly among low-income young women who reside in inner-city communities. The problem may be compounded by inadequate family planning services, particularly when such services are provided by general medical practices with high volumes of clients. This study examined the prevalence and correlates of pill-related side effects, with particular attention to the role of clinic characteristics. Participants were 177 pregnant and parenting African American adolescents and young women (average age = 18.34). The experience of a pill-related side effect was the most frequently cited barrier to birth control use, and it was significantly related to contraceptive behavior. Finally, although participants attending comprehensive clinics experienced more barriers to medical service use than those attending neighborhood clinics, they reported fewer problems with pill-related side effects and better psychological functioning. Implications for future research and policy are discussed.

The role of hormonal contraception in adolescents

Most pregnancies in women under age 20 years, as well as more than half of the pregnancies in the United States, are unintended. Contraceptive use is especially poor in adolescents, for whom the socioeconomic and educational consequences are great. A 1988 study indicated that more than 8% of sexually active adolescents had two or more sexual partners within the previous 3 months, higher than any other age group. The reasons why adolescents do not use contraception effectively fall into two categories: lack of access to contraceptive information and noncompliance with contraceptive recommendations. Studies have demonstrated that educational programs incorporating decision-making and communication skills, self-esteem enhancement, and peer influence can result in a decrease in the rate of adolescent sexual activity and pregnancy. Knowledge-based programs alone do not correlate with postponement of sexual activity or the use of contraceptives. In a survey of more than 4000 sex education teachers, 80% replied that they are in need of “factual information, materials, and strategies.” In a true/false examination given to educators on contraception, few correct answers were recorded regarding potential side effects of oral contraceptives. Effective counseling and communication with adolescents require an understanding of adolescent development. Most pregnancies in women under age 20 years, as well as more than half of the pregnancies in the United States, are unintended. Contraceptive use is especially poor in adolescents, for whom the socioeconomic and educational consequences are great. A 1988 study indicated that more than 8% of sexually active adolescents had two or more sexual partners within the previous 3 months, higher than any other age group. The reasons why adolescents do not use contraception effectively fall into two categories: lack of access to contraceptive information and noncompliance with contraceptive recommendations. Studies have demonstrated that educational programs incorporating decision-making and communication skills, self-esteem enhancement, and peer influence can result in a decrease in the rate of adolescent sexual activity and pregnancy. Knowledge-based programs alone do not correlate with postponement of sexual activity or the use of contraceptives. In a survey of more than 4000 sex education teachers, 80% replied that they are in need of “factual information, materials, and strategies.” In a true/false examination given to educators on contraception, few correct answers were recorded regarding potential side effects of oral contraceptives. Effective counseling and communication with adolescents require an understanding of adolescent development.

The role of hormonal contraception in adolescents

Most pregnancies in women under age 20 years, as well as more than half of the pregnancies in the United States, are unintended. Contraceptive use is especially poor in adolescents, for whom the socioeconomic and educational consequences are great. A 1988 study indicated that more than 8% of sexually active adolescents had two or more sexual partners within the previous 3 months, higher than any other age group. The reasons why adolescents do not use contraception effectively fall into two categories: lack of access to contraceptive information and noncompliance with contraceptive recommendations. Studies have demonstrated that educational programs incorporating decision-making and communication skills, self-esteem enhancement, and peer influence can result in a decrease in the rate of adolescent sexual activity and pregnancy. Knowledge-based programs alone do not correlate with postponement of sexual activity or the use of contraceptives. In a survey of more than 4000 sex education teachers, 80% replied that they are in need of "factual information, materials, and strategies. In a true/false examination given to educators on contraception, few correct answers were recorded regarding potential side effects of oral contraceptives. Effective counseling and communication with adolescents require an understanding of adolescent development.

Contraception in Germany: A review

In this paper studies on current contraceptive use and attitudes toward various contraceptive methods in Germany are reviewed. Both the former West and East Germany are considered. On the basis of the existing studies it is difficult to have a clear impression of which methods are currently used in both countries and how contraceptive practice developed over time, due to methodological differences between studies. Nevertheless, it can be concluded that use of reliable contraceptive methods is widespread in both East and West Germany. In this respect East Germany differs considerably from other previously communistic countries. Attitudes were mainly assessed in West Germany, and with respect to oral contraceptives and IUDs great concern appeared to exist regarding the safety of both methods. As far as oral contraceptives are concerned, selective mass media attention toward possible side-effects of oral contraceptives may have contributed to this situation.