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pubmed:otherAbstract |
PIP: From the 1st demonstration in 1937 that progesterone is an effective inhibitor of copulation-induced ovulation to the 1st combination oral contraceptive (OC), Enovid, the risks and hazards of OCs gradually presented and formulations have been changed, mostly reducing the estrogen content, in hopes of minimizing adverse effects. OCs remain the most effective contraceptive although there are many women who do not tolerate them, do not want IUDs, and prefer some method other than mechanical barriers. The author reports on an experiment with 490 women receiving pellets of oral conjugated estrogens in a monthly step-down fashion, reducing the number of pellets every 6 months, from 4 to 3 to 2 to 1 and after that 1 pellet every 6 months. Of these women 4 pregnancies occurred in 1540 women-years with minimal side effects. Another method, the postponement of menses after ovulation has already occurred, has been accomplished with 20-30 mg norethindrone administered daily beginning as late as day 24 of the cycle. The induction of ovulation with an antiestrogen (MER 25) was 1st reported in 1960; this was believed to have great potential as a contraceptive agent, but tests did not confirm this. It was found in 1961 that clomiphene citrate had a luteotropic effect. It has since been used successfully in cases of secondary amenorrhea, dysfunctional uterine bleeding, polycystic ovarian disease, and others. The incidence of successfully induced ovulation varies from 58-90%. Studies have also revealed markedly elevated levels of androgens and particularly testosterone in women with polycystic ovaries in comparison with normal controls. It appears that an inherent capacity for androgen production by the adrenal gland upsets hypothalamic-pituitary ovarian relations, stimulating the growth of follicles, luteinizing the theca and often certain cellular elements in the stroma. Another drug, danazol, is a new synthetic derivative of the 1st orally effective progestogen, ethisterone, and has proven to have an antiendometrial or endometrial-suppressing activity. It has proven effective in relieving the common symptoms of dysmenorrhea, pelvic pain, dyspareunia, mazoplasia, and mastodynia. It is currently used to reduce breast lumpiness.
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