[Oral contraceptives (author's transl)]

Abstract

A short review of the endocrinological basis of reproduction in the female is followed by a critical survey of the oral contraceptive methods in current use. The composition of the preparations, their use, their biological and use-effectiveness and mode of action are discussed.The importance is emphasized of complying with the basic principles of drug testing in the evaluation of effects of oral contraceptiveson health. Other effects than merely the contraceptive actions of these preparations are described in detail, including not only the undesirable, frequently neglected, yet very important beneficial effects on the drug-users, their children and families.

PIP: Of the oral contraceptives in current use, the most practical and effective are: 1) the combination pill (estrogen and progesterone in various combinations), with a contraceptive effect of almost 100%; 2) 2-phase treatment (estrogen and progesterone administered sequentially), which produces less negative side effects, but is slightly less reliable as an ovulation inhibitor; and 3) the minipill (containing only progesterone), which eliminates any estrogen-induced side effects, but is slightly more complicated as a medication. Continuous treatment with large combination dosages may be tried when complete elimination of menstruation is desirable. The monthly and weekly pills are still being tested. High dosages before or after coitus may be used in certain situations. Clinically undesirable side effects of oral contraceptives include urinary tract infections, fluor vaginalis, moniliasis, hypertension, water retention, lactation changes, and, less frequently, liver and skin disorders and modifications of the carbohydrate metabolism system. These can often be lessened or eliminated by changing to the minipill or to another preparation. A table indicates signs of excessive estrogen or progesterone influence. Extremely serious (sometimes life-threatening) side effects include persistent anovulation, thromboembolic disorders, liver tumors, and severe hypertension. Often the beneficial side effects of oral contraceptives are not mentioned, e.g., improvement or elimination of menstrual disorders, anemia, and acne, and prevention of benign breast and uterine tumors and ovarian cysts. The psychological benefits must also be taken into account. Fear of pregnancy is eliminated and birth control spacing results in improved health for mothers and children.