Some metabolic and hormonal changes in women using long acting injectable contraceptives.

Some metabolic and hormonal changes in women using longacting injectables as a contraceptive method were examined. The 2 main injectables utilized were depomedroxyprogesterone acetate (DMPA), given every 90 +or- 5 days, and norethisterone enanthate (NET/EN) injected every 60 +or- 5 days. None of the studied cases became pregnant during injectable use, indicating the high contraceptive efficacy of the method. No statistically significant changes were observed in hemoglobin, hematocrit, all protein fractions including albumin, alpha1, alpha2 beta, gamma immunoglobulins IgG, IgA, and IgM after 6 and 12 months in both groups of injectable users as compared with the preinjection values. Statistically significant suppression of the estimated hormones, Follitropin, Luteotropin, and Estradiol-17beta were detected in both groups of NET/EN and DMPA users, after 6 and 12 months, as compared with the preinjection values.

Acceptability study of the two versus three monthly injectable contraceptives.

PIP: The acceptability of 2 and 3 month injectable contraceptives was assessed and compared, and the acceptability of the injectables was further compared with that of oral contraceptives (OCs) and IUDs among a random sample of women, who attended a clinic in Alexandria, Egypt. The study was conducted by the University of Alexandria. The sample included 100 acceptors of the 2-month injectable, norethisterone oenanthate (NET-O EN), 100 acceptors of the 3-month injectable, depo-medroxy pregesterone acetate (DPMA), 60 OC acceptors, and 60 IUD acceptors. The women were interviewed prior to treatment and 2 or 3 times during the 6 months following their initial acceptance of the methods. Women who discontinued at any time during the 6-month period were interviewed concerning their reasons for discontinuing. The data was analyzed by calculating means and % distribution and by testing for significance. The percent lost to follow up was 12% for the NET-O EN group, 12% for DPMA users, and 0% for IUD and OC acceptors. The mean age of the acceptors was 30.4 years for NET-O EN, 30.7 years for DMPA, 28.3 years for OCs, and 25.2 years for IUDs. For these acceptor groups, the respective mean number of years of schooling was 6.1, 5.2, 7.2, and 7.5, and the respective mean number of pregnancies was 5.6, 5.4, 3.8, and 2.9. All 320 of the women were married, and 319 were Muslim. 99.4% lived in urban areas. 10% had no living male children, and 23.7% had no living female children. 2/3 of the injectable acceptors previously used 2 or more fertility control methods. A higher percent of IUD and OC acceptors, compared to injectable acceptors, reported using only 1 or no previous method. More than 1/2 of the injectable acceptors reported disruptions in their normal bleeding patterns. NET-O EN acceptors were more likely to experience heavy or prolonged bleeding while DPMA acceptors were more likely to report amenorrhea or a decreased flow. IUD acceptors were also bothered by bleeding problems. Almost all the women who reported changes in bleeding patterns were unhappy about the changes. Many of the women who reported amenorrhea worried that they might be pregnant. Women who experienced heavy or unpredictable bleeding worried about anemia and complained that bleeding interfered with their daily routines. 47.6% of the women reported weight gains, but this was generally viewed as an advantage. Nausea was the major side effect associated with OC use. 32% of the OC users, 28.0% of the NET-E ON users, 30.0% of the DMPA users, and none of the IUD users reported nausea. For all 4 groups, convenience and effectiveness were the major advantages the women attributed to their chosen method. Continuation rates were 68% for NET-O EN, 70% for DMPA, 75% for OCs, and 75% for IUDs. The major reason for discontinuation of injectables was bleeding problems. Among injectable users, a higher proportion of discontinuers (49%) than of continuers (20%) reported amenorrhea. The findings suggest that continuation for injectables could be improved if patients were given more detailed information about possible side effects and if they were advised to return to the clinic for treatment of any symptoms they experience.^ieng

A hematologic study of pregnant women in free and insurance hospital populations.

The prevalence of anemia among 631 women in late pregnancy was studied among two groups: those in the Medical Insurance Pregnancy Centre of the Alexandria clinic (320) and those in the free government hospitals (311). Some related demographic and social observations were also done. Complete medical and obstetric examinations and several laboratory tests were performed. Women in the insurance hospital had lower parity, smaller families, lower crowding index, better income and a healthier hematological picture than women in the free hospitals.

Blood hormone levels in egyptian women on norethisterone oenanthate.

Ten Egyptian women who were using the injectable contraceptive norethisterone oenanthate (NET-OEN) for at least 6 months were monitored weekly for a period of 12 weeks by measuring 3 pituitary hormones (FSH, LH and prolactin) and 2 ovarian hormones (oestradiol 17-B and progesterone). It was concluded that NET-OEN is a strong ovulation inhibitor, at least after its use for 6 months. Prolactin levels were depressed and this is in contradiction with the findings in rats.

PIP: 10 Egyptian women who were using the injectable contraceptive norethisterone enanthate (NET-EN) for at least 6 months were monitored weekly for a period of 12 weeks by measuring 3 pituitary hormones (FSH, LH, prolactin) and 2 ovarian hormones (estradiol 17-B and progesterone). It was concluded that NET-EN is a strong ovulation inhibitor, at least after its use for 6 months. Prolactin levels were depressed and this is in contrast to the findings in rats.

A preliminary pharmacological trial of the monthly injectable contraceptive cycloprovera.

A comparative pharmacological pilot study of the monthly injectable contraceptive CycloProvera was carried out in 11 women in four centres. There were no significant differences in the results between the centres except that the injection-bleeding interval appeared to be shorter in Swedish women than in those in Havana and Mexico. Medroxyprogesterone acetate was detectable in blood for 28 to 62 days after injection of CycloProvera and although follicular activity returned in less than 28 days after injection in many of the women, corpus luteum function was suppressed for at least seven weeks in all women. Most of the women retained a regular menstrual pattern; six of 33 cycles were amenorrhoeic. There was no significant change in any of the biochemical and haematological analyses.

Pharmacokinetics of ethynyloestradiol in women for different populations.

The pharmacokinetics of a dose of 50 microgram ethynyloestradiol administered orally was studied in fourteen centres. Absorption was rapid and the highest serum concentrations of total ethynyloestradiol were found in most subjects at 1 h and by 24 h concentrations were less than 250 pg/ml. Calculation of the half-lives for absorption, distribution and elimination showed wide variations between subjects, the half-life of elimination varying from 2.5 h to more than 30 h. Bioavailability as measured by the area under the serum ethynyloestradiol concentration-time curve also showed more than a ten-fold variation. Intra-centre differences in the various parameters measured were as large as the inter-centre differences.

Epidemiology of abortion in Alexandria.

PIP: An epidemiologic study of 10,202 women who had abortions in Alexandria, Egypt was conducted. The study was prospective in 5171 cases and retrospective in 5171 cases and retrospective in 5031 cases. The study was hospital based in 3 hospitals in Alexandria. The results were analyzed separately because of the different approach to the study of the 2 groups. The great majority of the women who had abortions were urban dwellers in both groups. The rate of induced abortion was 2-1/2 times more frequent in the prospective and 18 times more in the retrospective urban than in rural cases. The highest rate of abortion was among the illiterate women. The treatment of the different types of the prospective group was nonsurgical in 1615 cases, surgical evacuation in 2638 cases and more than 1 therapy in 918 cases. The mortality rate was 135/100,000, which is rather high, and the mortality of abortion was more than the total maternal mortality. Hemorrhage was the most frequent complication in both prospective and retrospective cases. The most frequent reason given by prospective study women for refusing family planning (49.62%) was that they had no children. In the retrospective study group, 31.52% practiced family planning following the abortion, and the most common reasons for not practicing family planning was having no children. Education of the population appears to be the key in the problem of abortion. Along with improving the income of the family and its health conditions it is necesary to increase the acceptability of the couple for family planning.^ieng

Rate of metabolism of norethisterone in women from different populations.

The rate of metabolism of orally administered norethisterone was compared in fourteen centres by measuring plasma levels of the steroid by radioimmunoassay at varying times after oral administration of a 1 mg dose. The inter-centre differences were of the same order as the intra-centre differences. Variations in metabolism appeared not to be due to variations in body size.

Human tubal fluid collection via vagina and its quantitative variations during the menstrual cycle.

The culdoscope was used for easy approach to the fallopian tube, which was delivered into the vagina, and a Foley catheter (No. 8 French) was introduced through its fimbrial end for collection of human tubal secretion. It was left from one to eight days. The technique was successful in 54 cases out of 60, but we succeeded in collecting enough fluid in 44 cases only. The volume of human tubal fluid was studied in relation to the phase of the cycle. A peak of fluid volume was found to occur at the midcycle.

The effect of an oral contraceptive on the pulmonary functions.

PIP: The effects of a combined oral contraceptive (OC) Gyn-Anovlar (norethisterone acetate 3 mg, ethinyl estradiol .05 mg), on the pulmonary functions, both after short- and long-term use were studied in 106 women taking the compound for periods of 6 months to 8 years. Controls were normal women who had not taken any OCs. After physical examinations, lung volumes and capacities were tested. X-ray examinations of the chest and electrocardiographic (EKG) studies were made. Radiologic and EKG findings were normal. Lung volumes and capacities revealed no statistically significant differences from controls. Ventilatory studies and pulmonary compliance results were comparable to those of controls (p greater than .05). Restructive or obstructive pulmonary dysfunction or hyperventilation were not present. Several of these pulmonary functions have changed in normal pregnancies. Pulmonary function studies have been of value in the early diagnosis of thromboembolism. No such cases occurred in this study. Data show that the effects of the combined OC were fairly benign.^ieng

Contribution of fetal/maternal incompatibility to aetiology of pre-eclamptic toxaemia.

Data are presented on an association between toxaemia of pregnancy and consanguinity of patients, seen at a Turkish hospital, and their husbands. Women with toxaemia were less frequently related to their husbands than those with no signs of pre-eclampsia. The relationship between toxaemia in twin pregnancies and the sexes of the twin pairs from four sources are examined. In all four pre-eclampsia seems to be more common in unlike-sex than in like-sex twin pregnancies, and, by extension, to be more common in dizygous than in monozygous twin pregnancies.