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  • Title: Ultrasound evaluation of ovarian activity under oral contraceptives.
    Author: Hoogland HJ, Skouby SO.
    Journal: Contraception; 1993 Jun; 47(6):583-90. PubMed ID: 8334892.
    Abstract:
    The trend towards changing the composition of the contraceptive pill in order to decrease side effects might lead to increased ovarian activity. This may decrease reliability. Therefore, a non-invasive method for monitoring the suppressive effect of the pill on ovarian function is warranted. The aim of the present study was to investigate whether or not diagnostic ultrasound might be the method of choice for studying residual ovarian activity during pill use. In 89 women on a low-dose oral contraceptive (30 mcg ethinyl-estradiol (EE)/75 mcg gestodene), the first two months of pill-intake were monitored extensively with diagnostic ultrasound. The study revealed that only one ultrasound investigation was needed during the first week of pill intake to discover all relevant cases of residual ovarian activity. Follow-up investigations are needed to quantify this activity more specifically. Physicians used ultrasound (Scanner 1150) on 89 women at medical centers in Maastrict in the Netherlands and Copenhagen in Denmark for 2 menstrual cycles to evaluate ultrasonography's scientific value in monitoring residual ovarian activity while women are taking low dose oral contraceptives (OCs). They performed transvaginal scanning in 89% of menstrual cycles and transabdominal scanning in the other cycles. They took blood samples to measure hormone levels and to compare these levels with ultrasound findings. The women used a low dose OC with 30 mcg ethinyl estradiol and 75 mcg gestodene. Ultrasound detected all cases of hormonally active ovaries as confirmed by serum ethinyl estradiol levels. The first ultrasound investigation conducted between pill intake days 0 and 4 revealed the highest proportion (13%, 23 of 176 cycles) of folliclelike structures (mean diameter, 18.9 mm). Between days 5 and 8, the proportion was still relatively high (12%) and the structures remained essentially the same size (18.3 mm). In 87% of the cycles with structures, the observed structures during the second investigation were likely the same structures observed in the first investigation. The third ultrasound investigation between days 10 and 12 detected continued folliclelike structures (mean diameter, 20.4 mm) in only 57% of women who had structures earlier. A rescan of women who did not have structures earlier did not detect any folliclelike structures, resulting in an overall proportion of cycles with structures of 7%. These findings suggested that ultrasound can reliably detect residual ovarian activity in women using low dose OCs, but the first ultrasound scanning should occur between days 0-7 to detect residual ovarian activity. Physicians should reexamine only those cases with structures greater than 10 mm every 2-4 days until they can determine the degree of ovarian activity. Should further studies confirm these findings, ultrasound monitoring could replace Pearl index studies to evaluate the efficacy of new hormonal contraceptives.
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