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  • Title: An appraisal of certain problems involved in the use of steroid compounds for contraception.
    Author: Hertz R.
    Journal: Caribb Med J; 1966; 28(1-4):26-35. PubMed ID: 12255250.
    Abstract:
    The problems of oral contraception considered are: possible carcinogenesis, thrombophlebitis or thromboembolism, and possible effect on the reproductive or genetic potential of the ova. Estrogen-progestogen combinations produce characteristic effects of estrogen, indicating that the estrogen given exceeds normal endogenous estrogen production. In humans all known carcinogenic agents involve a latent period, many for a decade or more. Both endogenous and exogenous estrogens have been shown to modify the activity of established breast cancer in humans. The effect on the preclinical phases is unknown. Effects of prolonged use of estrogens on breast cancer will require more extensive studies. Endometrial cancer has been reported to undergo regression under intensive progesterone therapy. Other known carcinolytic agents such as X-rays and alkylating substances are known to be carcinogenic under some conditions. One may, therefore, question the advisability of derangement of such endocrinological relationships. Distinctive histological changes in the endometrium after use of estrogen-progestogen mixtures have been described. Such atrophic changes represent drug-induced pathology. Although these changes disappear when therapy is discontinued, the latent effect is unknown. Since the pathogenic period for cancer of the cervix is estimated to be 7-10 years, studies of this possible effect should exceed this time span and be carefully devised so that data can be compared. Data reported so far do not provide a sound statistical basis. Immediate effects on cervical dysplasia have not been shown to be unfavorable. Thrombophlebitis and thromboembolic phenomena have been reported but on the basis of available data no significant increase in risk has been demonstrated. Studies of carcinogenesis in animals are readily reproduced. However, the human population is so heterogenous that the genetic factor is uncertain. The ultimate effect of oral contraceptives on the ova is unknown. So far observations have shown none. Each physician prescribing these drugs should evaluate the risks involved with due regard for the results of alternate methods of contraception available.
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