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  • Title: Contraceptive steroid effects on nonreproductive organ systems.
    Author: Corson SL.
    Journal: J Reprod Med; 1986 Sep; 31(9 Suppl):865-78. PubMed ID: 3772906.
    Abstract:
    Oral contraceptives affect many organ systems in addition to the reproductive tract. In some cases the alteration is just a clinical laboratory test result value; in others it represents a true alteration in metabolism, with the induction of increased enzyme activity. Even with the markedly reduced steroid content of today's oral contraceptives, the practitioner must continue to be aware of these potential and real effects on nonreproductive organ systems. How oral contraceptives (OCs) affect the nonreproductive organ systems depends on both the dose and choice of the estrogenic and progestational components and the interaction between the 2. Several animal model systems have been used to measure the potencies of these agents and their estrogenic-androgenic metabolic effects. These test results have been combined with human data from delay-of-menses tests and gonadotropin-suppression studies to differentiate between commercially available combinations. There has been a tendency to place less importance on animal studies because the data correlate poorly with human experience. Ongoing studies provide particularly valuable information. In a study conducted at the Northwest Lipid Research Clinic at the University of Washington, Seattle, the clinical chemistries of women using OCs and replacement estrogen were compared with those of nonusers. OC users and those on estrogen replacement therapy had lower levels of alkaline phosphates than nonusers when adjusted age-specific values were compared. Mean SGOT and bilirubin levels were statistically lower than in OC users. Knopp, with the same group, also investigated the effects of pregnancy and OC use on clinical serum chemistry. OC users and women who were 36 weeks pregnant were compared with nonpregnant women who did not use OCs. Total plasma bilirubin concentration was lower in OC users (29%) and pregnant women (32%). Plasma glucose levels showed a wider variation: 3% lower in OC users and 17% lower in pregnant women as compared with the controls. Discordancy was noted for SGOT levels, with a 9% decrease in OC users but a 27% increase in pregnancy. Commonly used biochemical indexes are influenced differently by the estrogen and progestin components of the pill. Yet, even recently published longitudinal studies evaluated doses no longer commonly used. Because some of these changes seem to be dose related in part, it is necessary to continue to study the newer preparations. In 1975, Wynn reviewed the issue of OC use and vitamins. He noted that vitamin A was increased 30-80% in OC users as a consequence of an estrogen-mediated increase in retinol-binding protein. Thiamine (B1) and pyridoxine (B6) were decreased; vitamin C was decreased by 30-40% in OC users but not enough to reach deficiency ranges. In 1966 Shearman called attention to post-pill amenorrhea. 9 of 86 patients with secondary amenorrhea had experienced the onset after cessation of OC use. Conversely, in 1977 Jacobs et al. analyzed 131 consecutive cases of secondary amenorrhea and concluded that OC use did not cause that disorder. Dickey and Berger discussed the incidence of post-pill amenorrhea over various time periods and reported an estimated 2-2.6% at 6 months after cessation of OCs. Bennion et al. demonstrated the effect of OCs on bile composition in 22 women; OCs increased gall bladder bile cholesterol saturation. Because OCs markedly decrease the ovarian production of androgens, decrease adrenal production of the precursors, and increase sex-binding globulin, its therapeutic effect is broad based.
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