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  • Title: Formulation and noncontraceptive uses of the new, low-dose oral contraceptive.
    Author: Batzer FR.
    Journal: J Reprod Med; 1984 Jul; 29(7 Suppl):503-12. PubMed ID: 6237195.
    Abstract:
    Although contraceptive efficacy is the major reason for using oral contraceptives (OCs), other physiologic changes occur with them that can be beneficial to patients. The new, low-dose OCs are of particular interest in this regard. Whether the differences in progestin-estrogen formulations of oral contraceptives (OCs) lead to any clinically significant differences is an important question, even though the concept of "tailoring the pill to the patient" has assumed less importance as the hormonal dosages have decreased. Each component can be evaluated individually, but it is often difficult to predict the result of their combined action. All of the new low-dose formulations contain the same estrogen, ethinyl estradiol (EE). Although the type of progestin in low-dose OCs is probably of little significance for efficacy and cycle control, it may be more important in regard to lipid and carbohydrate metabolism. Combined OC therapy acts simultaneously at various levels of the reproductive system, and contraceptive efficacy of pills with less than 50 mcg of estrogen probably results from these combined actions. The action of estrogen and progesterone is synergistic: the sustained estrogen component exerts negative feedback on gonadotropin secretion, provides stability to the endometrium, and increases the potency of the progestational agent, while progestin can influence only estrogen-primed tissue. The progestin suppresses luteinizing hormone secretion; in addition, progestational influence dominates estrogenic influence in affecting the remainder of the reproductive system. Previous OC usage may delay pregnancy by several months but does not impair longterm fertility potential or increase congenital anomalies or abortions if conception occurs subsequent to the 1st post-pill cycle. Breakthrough bleeding, which occurs in 15% of users, is the single most frequent cause of pill discontinuation but appears to be of no medical consequence. Breakthrough bleeding and amenorrhea may be controlled by changing the pill formulation. Depression has been reported in 5% of OC users, but pill use appears to alleviate premenstrual tension. The individual patient's risk-benefit ratio must be considered when noncontraceptive uses of the pill are contemplated. OC use has been cited as a cure for dysmenorrhea, although the mechanism is uncertain. The possible preservation of fertility or prevention of progression of endometriosis with cyclic pill use should be investigated. The controlled sloughing of a uniformily thinning endometrium prevents and controls dysfunctional uterine bleeding, endometrial hyperplasia, and the anemia that results. Use of OCs has been recommended in treatment of hirsutism to suppress ovarian function when the hypersecretion of androgens is documented. Since both adrenal and ovarian androgens are often involved in hirsutism, the combined suppressive actions of OCs frequently are beneficial. Estrogens also decrease sebum production and often result in indirect acne improvement. Cyclic estrogen-progesterone therapy is recommended for inducing sexual maturation in primary amenorrhea secondary to gonadal failure.
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