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  • Title: [Oral contraception: evolution of concepts over the last thirty years].
    Author: Belaisch J, Hommais-loufrani B.
    Journal: Contracept Fertil Sex (Paris); 1987 Nov; 15(11 Suppl):1-8. PubMed ID: 12281408.
    Abstract:
    Results of a survey of gynecologists and general practitioners in France concerning their opinions of the advantages and drawbacks of oral contraceptives (OCs) and a brief history of the successive improvements in OCs over the past 3 decades are presented. The 300 gynecologists and 600 general practitioners interviewed in all regions of France felt that OCs were an important contraceptive method. Almost all reported they were very concerned about possible longterm effects: 78% with cardiovascular risks, 77% with lipid metabolic effects, 63% with glucose metabolic effects, and 62% with androgenic effects. Fewer than 1/2 were very concerned about shortterm clinical problems such as weight gain, spotting, and dermatological effects which have less serious prognoses. Almost 90% of the physicians considered that too high a dose of estrogen dominance was a very important cause of problems. Over 1/2 of the physicians felt that information furnished them regarding OCs should be more detailed and precise. Enovid, the 1st combined OC commercially available in the US, contained 150 mcg of mestranol and 9.85 mg of norethynodrel. Isolated cases of serious vascular problems began to be reported soon after its introduction. In 1961 a formulation with half the estrogen dose was developed, and in 1964 ethinyl estradiol, a better tolerated synthetic estrogen, replaced mestranol and is still the only estrogen used. New and better tolerated progestins were subsequently synthesized, as were formulations with lower steroid doses. Results of large epidemiological studies demonstrated that estrogens were responsible for venous thromboembolic accidents while progestins were directly correlated with arterial accidents. No increased risk of breast cancer has been found in OC users in the most recent controlled studies. Hepatic or biliary problems are possible because of the hepatic catabolism of the steroids, justifying the contraindication for women who have had hepatic accidents. Headaches are usually but not always harmless. Weight gain is due not to increased adipose mass but to water retention and is often responsible for termination of use. Benefits of OCs include effective fertility control and regular medical surveillance of users, which allows medical problems to be discovered at earlier stages. OCs have favorable effects on dysmenorrhea, spontaneous hyperestrogenism, endometriosis and provide protection against-rheumatoid polyarthritis and osteoporosis. The recent development of biphasic and especially triphasic pills has provided better cycle control at the same time that steroid doses have been reduced. The next innovation in combined OCs will probably be the use of new progestins combining powerful antigonadotropic action with an absence of metabolic effects at contraceptive doses. Gestodene, a derivative of 19 nortestosterone, offers great promise. Its use will decrease the effects of combined OCs on different metabolic factors that influence individual cardiovascular risk.
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