The Effects of Hormonal Contraception on the Voice: History of Its Evolution in the Literature.

OBJECTIVES: Women of reproductive age commonly use hormonal contraceptives, the vocal effects of which have been studied. Otolaryngologists should be aware of this relationship to make recommendations on hormonal contraception as it relates to each patient's voice requirements. METHODS/DESIGN: A comprehensive literature review of PubMed was completed. The terms "contraception," "vocal folds," "vocal cords," and "voice" were searched in various combinations. Articles from 1971 to 2015 that addressed the effects of contraception on the vocal folds were included. RESULTS: In total, 24 articles were available for review. Historically, contraception was believed to affect the voice negatively. However, more recent studies using low-dose oral contraceptive pills (OCPs) show that they stabilize the voice. However, stabilization generally occurs only during sustained vowel production; connected speech appears unaffected. Therefore, singers may be the only population that experiences clinically increased vocal stability as a result of taking hormonal contraceptives. Only combined OCPs have been studied; other forms of hormonal contraception have not been evaluated for effects on the voice. Significant variability exists between studies in the physical attributes of patients and parameters tested. CONCLUSIONS: Hormonal contraception likely has no clinically perceptible effects on the speaking voice. Singers may experience increased vocal stability with low-dose, combined OCP use. Other available forms of contraception have not been studied. Greater consistency in methodology is needed in future research, and other forms of hormonal contraception require study.

[A tribute to Carl Djerassi]. / Tributo a Carl Djerassi.

On January 15, 2015, Carl Djerassi, an extraordinary personality, died at the age of 91 years. He was born in Vienna, Austria, on October 29, 1923. His parents were physicians and probably he wanted to be also a physician, but sooner than later he chose to be a chemist. In 1939 he arrived to live to New York with his mother. In 1945 he became American citizen. Part of his work is the first commercial antihistamine, pyribenzamine, and the first successful combined oral contraceptive pill. With this editorial we make a tribute to this steroid pioneer.

El 30 de enero de 2015 falleció, a la edad de 91 años, Carl Djerassi, un personaje extraordinario. Nació en Viena, Austria, el 29 de octubre de 1923. Sus padres eran médicos y quizás por esa razón él también quería serlo, pero pronto escogió la química. En 1939 llegó con su madre a vivir a Nueva York y en 1945 se naturalizó estadounidense. Son obra suya el primer antihistamínico comercial (la piribenzamina) y el compuesto farmacológico de la píldora anticonceptiva. Sirva el presente editorial como un homenaje a este pionero de los esteroides sintéticos.

Oral contraceptives and the periodontium.

Oral contraceptives are a safe and effective means of contraception for millions of women worldwide. The first formulations of these drugs contained much higher doses of estrogens and progestins than those available today, and these were associated with an unacceptably high rate of unwanted effects including serious cardiovascular events. In addition, a number of case reports and clinical studies suggested that use of the first generation oral contraceptives was also associated with an increased risk for gingival and/or periodontal disease. Unfortunately, many of these early studies suffered from significant methodological flaws which throw their findings into question. Nonetheless, these studies provided the basis for a perception among the dental profession that oral contraceptives increase the risk for gingivitis and/or periodontitis. Realisation that the adverse events profile of oral contraceptives was dose dependant led to the development of the modern low dose formulations that are in use today. There have been far fewer studies to investigate whether modern oral contraceptives have any impact on the periodontium compared to studies of the early contraceptive formulations, but the quality of the more recent research is undoubtedly better. Following extensive review of the relevant literature and consideration of the historical perspective, the best available evidence strongly supports that oral contraceptives no longer place users at any increased risk for gingivitis or periodontitis. Oral contraceptives should not be viewed as a risk factor for gingival or periodontal disease.

The effects of hormonal contraceptives on female sexuality: a review.

INTRODUCTION: Hormonal contraceptives can influence female sexual function. AIM: The goal of this article was to provide a comprehensive review of the effects that various hormonal contraceptives may have on female sexual function. METHODS: A Medline search was conducted using several terms related to and including the terms contraception, oral contraceptive, female sexual function, dyspareunia, libido, and sexual desire. RESULTS: A thorough review of the effects of hormonal contraceptives on female sexual function. CONCLUSIONS: The sexual side effects of hormonal contraceptives are not well studied, particularly with regard to impact on libido. There appears to be mixed effects on libido, with a small percentage of women experiencing an increase or a decrease, and the majority being unaffected. Healthcare providers must be aware that hormonal contraceptive can have negative effects on female sexuality so they can counsel and care for their patients appropriately.

Medicalizing reproduction: the pill and home pregnancy tests.

This article explores one chapter in the history of medicalization through a focused study of oral contraceptives and home pregnancy tests. Each commercially successful in developed nations and both decades old (the Food and Drug Administration approved oral contraceptives in 1960 and home pregnancy tests in 1977), these reproductive technologies created the first pharmaceutical mega-market comprised of young, healthy, sexually active, heterosexual women. Examining the discrete, but interconnected, histories of both products, this article explores how the Pill's popularity and profitability medicalized and feminized contraception, encouraging pharmaceutical companies to invest in the development of patented variants of hormonal contraception and creating a means by which the under-used Pap smear could be introduced to a population that had previously resisted it. Home pregnancy tests, too, had unintended consequences. Designed to shield the detection of a pregnancy from a "medical gaze," the test's widespread use encouraged women to become medical patients at an earlier stage of their pregnancy.

A new estradiol-dienogest oral contraceptive marks "The Pill's" 50th anniversary.

Oral contraceptive pills were first approved by the Food and Drug Administration 50 years ago. Discovery of the physiology of reproduction and demonstration of the ability to inhibit ovulation with ovarian extracts laid the early groundwork for the development of contraceptives. Later, characterization of the hormones controlling ovulation and synthesis of progestins allowed production of oral contraceptives. Modern estrogen and progestin pills have undergone significant changes since their initial introduction. New formulations have been developed, doses have been lowered, and extended use introduced. The Food and Drug Administration has recently approved a new oral contraceptive containing estradiol valerate and dienogest. This pill contains an orally active estradiol in combination with a progestin with strong endometrial activity. The decreasing estrogen dose combined with an increasing progestin dose decreases the risk of break through bleeding when compared to previous estradiol valerate formulations. The contraceptive efficacy and a tolerability of this new pill are similar to currently marketed low dose combined estrogen-progestin oral contraceptives.

"Momma's Got the Pill": How Anthony Comstock and Griswold v. Connecticut Shaped US Childbearing.

The 1960s ushered in a new era in US demographic history characterized by significantly lower fertility rates and smaller family sizes. What catalyzed these changes remains a matter of considerable debate. This paper exploits idiosyncratic variation in the language of "Comstock" statutes, enacted in the late 1800s, to quantify the role of the birth control pill in this transition. Almost 50 years after the contraceptive pill appeared on the US market, this analysis provides new evidence that it accelerated the post-1960 decline in marital fertility.

Ludwig Haberlandt--A pioneer in hormonal contraception.

Ludwig Haberlandt (1 February 1885 - 22 July 1932), pioneer in hormonal contraception, was born in Graz, where he graduated from the university in 1909 in medicine summa cum laude and began his career as a physiologist. The idea of temporary hormonal contraception in the female body entered his mind in February 1919, when he was already Professor of Physiology in Innsbruck. He pursued his project ambitiously and by 1921 demonstrated temporary hormonal contraception in a female animal by transplanting ovaries from a second, pregnant, animal. From 1923, after further successful scientific work in this field, he began highlighting the importance of clinical trials in presentations. From then, he was criticized by his colleagues, who accused him of hindering unborn life. His idea was contradictory to the moral, ethic, religious and political agendas of that time in Europe. In 1927 official reports escalated, his family was ostracized by the local population, and Ludwig Haberlandt refused any further interviews. Against all opposition, in 1930 he began clinical trials after successful production of a hormonal preparation, Infecundin, by the G. Richter Company in Budapest, Hungary. Although at the peak of his scientific career, he was unable to pursue other scientific agendas because of the disputed contraception project. After he committed suicide, on 22 July 1932, scientific discussion about hormonal contraception ceased until 1970 when scientists began referring to his earlier medical and scientific work.

Hormonal contraceptive methodology: an historical review.

The introduction of the first hormonal contraceptive was one of the most important events of the twentieth century for women. The availability of oral contraceptives (OCs) provided women with greater control over their reproductive lives. As OC usage steadily increased, so did concern over health risks associated with their use. Concluding that adverse events were dose-related, scientists sought to develop lower-dose formulations. In the four decades since the first OC, women seeking contraception have benefited from the development of non-oral hormonal delivery systems, including injectables, intrauterine devices, implants, a vaginal ring, and a contraceptive patch. It is hoped that this expanding menu of choices affords women opportunities to find methods better suited to their individual needs. Clinicians should continually evaluate their patients' hormonal contraceptive needs, and provide adequate counseling so that every woman is afforded the opportunity to achieve contraceptive success.

Nongenital malformations following exposure to progestational drugs: the last chapter of an erroneous allegation.

In the late 1960s and 1970s, a number of epidemiological studies were published indicating that pregnant women who were exposed to an array of sex steroids delivered infants with an increased incidence of nongenital congenital malformations. Because of these publications, the Food and Drug Administration (FDA), in conjunction with various pharmaceutical companies, labeled the therapeutic exposure of progestational drugs and contraceptives in pregnant women as a risk factor for limb-reduction defects (LRDs) and congenital heart defects (CHDs). Subsequently there was a rapid decrease in the exposure of pregnant women to these drugs and the initiation of numerous lawsuits alleging that a particular progestational drug was responsible for a child's nongenital congenital malformation. Wilson and Brent (1981) published an article indicating that epidemiological and animal studies of these drugs, and basic science did not support the package insert's warnings. Many new and previous animal and epidemiological studies did not support the FDA box warning. In 1987 the FDA held a hearing in which the FDA, the Teratology Society, the Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecology, and other organizations supported the position that progestational agents did not result in nongenital malformations. An editorial appeared in Teratology congratulating the FDA for removing the warning label on oral contraceptives regarding nongenital malformations. In 1999 the FDA published new wording for package inserts that removed warnings for nongenital malformations for all progestational agents. In spite of the recent changes in the package inserts, lawsuits have alleged that progestational drugs cause nongenital malformations. It took 22 years from the time a box warning was required by the FDA until the warnings were removed in 1999. The 1999 FDA publication, which is a scholarly and objective document, should put an end to 2 decades of concern and anxiety for pregnant women or women of reproductive age. Could scientists, the pharmaceutical companies, or the FDA have prevented the mislabeling of progestational drugs with regard to their teratogenic risks? Was the epidemiological or teratology community at fault because they did not critique and respond to the early publications? Did the FDA act too slowly? The epidemiologic analyses, animal studies, and basic science principles have been reviewed, and it is obvious that clinically utilized progestational drugs do not cause nongenital malformations (i.e., LRDs and CHDs).