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Contracept Fertil Sex (Paris). 1984 Mar;12(3):479-82.
[Drug interactions with contraceptive methods]

[Article in French]

Simon P, Hakkou F, Warot D.

PIP: 3 possible types of drug interactions with contraceptives involve oral contraceptives (OCs), IUDs, and spermicides. The interaction of combined OCs with various drugs is frequently discussed in the literature, but the reported facts are sometimes contradictory. Case studies have indicated failure of OCs in patients taking ampicillin, but comparative studies using ampicillin and placebos have shown no difference in rates of estrogen, progestogens, follicle stimulating hormone, or luteinizing hormone in the 2 groups. Individual differences and predispositions among some women appear to play a role in drug interactions. The clinician should be wary of modifying accepted prescription practices too readily in the face of findings that may be explained by other as yet undisclosed factors. Interactions are difficult to establish, as are their mechanisms. They may perhaps be explained by the estrogen or progestogen components of the pills, the timing of the antibiotic dose, the duration of treatment and the dosage used, resistance of the intestinal flora, self-medication, or other factors. The drug troleandomycin is a special case; it appears to favor the already existing tendency of OCs to provoke cholestatic jaundice. A table of drug interactions with OCs can be divided into 2 parts, those that have been confirmed and whose mechanisms of action are known, including antiepileptics such as phenobarbital, butobarbital, phenytoin, and primidone, and the drug rifampicin, which are enzyme inductors; and those that are suspected but as yet unconfirmed and whose mechanism of action is not established. The unconfirmed interactions involve a variety of effects in addition to pregnancy. It is not yet established whether enzyme inductors are a greater problem for users of low-dose pills, but the probable existence of individual variations in sensitivity causes problems in setting recommendations applicable to all patients. Interactions between progestogen-only OCs and other drugs have not been reported, perhaps because they have been in use for a short time and their use is somewhat restricted. It is possible that use of anti-inflammatory drugs in midcycle attenuates the inflammatory effect of the IUD at the endometrial level, thereby augmenting the risk of pregnancy, but thus far the effect has not been proven. Drug interactions with spermicides are difficult to detect because of their less than total effectiveness, but users are warned to employ another method if they are undergoing any kind of vaginal treatment with another product.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12265944&dopt=Abstract

Network. 1984 Autumn;6(1):7-8.
Contraceptive potential of analogs of LH-RH.

Schally AV.

PIP: Nearly 2000 analogs of luteinizing hormone (LH)-releasing hormone (RH) have been synthesized since 1971. This paper reviews new developments of contraceptive methods based on these analogs. Approaches to female contraception based on LH-RH agonists have the advantage of reversibility, but have been impeded by problems such as bleeding irregularities, nonuniform inhibition of follicular maturation, and effects of unopposed estradiol secretion on the endometrium. Moreover, careful timing is required for administration of these agonists. Spermatogenesis was inhibited as a result of administration of LH-RH agonists ot men, but the fall in testosterone levels produced impotence and hot flashes. The approach based on combined administration of LH-RH agonsits and testosterone for male contraception requires extensive investigation. Research has also aimed to use LH-RH antagonists to block the midcycle surge of LH and follicle-stimulating hormone (FSH) necessary for ovulation; however, the results of longterm toxicity studies must be awaited. Experiments in rats suggest that antagonists may inhibit spermatogenesis as well. The most convenient and effetive method of administering LH-RH agonsits appears to monthly intramuscular injection of microcapsules made from a biodegradable biocompatible polymer and designed for controlled release over a 30-day period. Intranasal administration also holds promise.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12266403&dopt=Abstract

Acta Ginecol (Madr). 1984 Apr;41(4):201-6.
[Amenorrhea following the administration of oral contraceptives]

[Article in Spanish]

Gertrudis Diez MA.

PIP: It is estimated that about 2.2% of women experience amenorrhea and anovulatory cycles after discontinuing use of oral contraceptives (OCs), although exact figures are lacking due to differences of definition and problems of diagnosis. Several possible mechanisms to explain the occurrence of postpill amenorrhea have been suggested, including endometrial atrophy and fibrosis, changes in the ovaries similar to those found in Stein-Levanthal syndrome, hypothalamic disorder, late menarche, irregular cycles, and periods of amenorrhea before or during OC use. Previous pregnancies, duration of pill use, and formulation utilized are apparently not related to occurrence of post-pill amenorrhea. Clinical diagnosis requires detection of ovulation by means of basal body temperature, cervical mucus changes, and vaginal smears. If amenorrhea persists after administration of a progestagen to induce bleeding, more complete examinations must be done to exclude pituitary tumor, Cushing's syndrome, thyroid problems, and possible precocious menopause or anorexia nervosa. X-rays, administration of thyroid or suprarenal hormones, gonadotropins, or estrogens, an endometrial biopsy, or laparoscopy may be necessary. Generally all test values are normal except that levels of estrogens, follicle stimulating hormone, and luteinizing hormone are usually reduced. Treatment of post-pill amenorrhea can take various forms. About 5% of cases appear to resolve spontaneouusly; efforts should therefore be made to detect ovulation through basal body temperature, cervical mucus and vaginal smears. Corticosteroids including prednisone and dexametasone may administrered, or if estrogen levels are low and the patient fails to respond to progestagens with withdrawal bleeding, clomiphene may be used. Human menopausal gonadotropin or human chorionic gonadotropin can be in patients with low estrogen levels who do not respond to clomiphene. Ergocriptine derivatives may be used in cases with associated galactorrhea due to basal hyperprolactinemia. Palliative treatment with OCs may be used in patients who wish to avoid pregnancy. The prognosis is always poor in the presence of galactorrhea or if progestagen administration is not followed by withdrawal bleeding or estrogen levels are low. Treatment is usually futile in cases of polycystic ovaries that have sclerosed. The most significant feature of such amenorrhea is its role in infertility. If the patient wishes to become pregnant after some period of OC use, it is advisable to interrupt treatment periodically until 1-2 normal menstrual cycles have reappeared, especially in young patients who had irregular cycles before initiating hormonal contraception.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12267262&dopt=Abstract

Contracept Fertil Sex (Paris). 1986 Jul-Aug;14(7-8):675-81.
[Rendering follicle tubes permeable again after post-partum sterilization. A report on 25 cases. Should post-partum sterilization be performed or not?]

[Article in French]

Body G, Sagot P, Sauvanet E, Cancel J, Lansac J.

PIP: This article discusses the success of microsurgical reversal attempts after postpartum tubal sterilization and assesses the risk of later reversal requests after postpartum sterilization. 25 of 37 requests for tubal sterilization reversals received by the authors between January 1977-December 1983 followed postpartum sterilizations. The only criteria were contraindications to another pregnancy, a history of bilateral salpingectomy, and existence of a serious hypofertility factor. No minimal tubal length was required. All reversal procedures were microsurgically performed by 3 operators. The average age of patients was 26.7 years at sterilization and 32.5 years at reversal. Ages ranged from 25 to 41 at reversal. The parity of the women ranged from 2 to 9 and averaged 4.2 children. The sterilization was performed during a cesarean section in 19 cases, of which 8 were emergency procedures. The indication for the sterilization was medical in only 7 cases. 20 of the procedures were tubal ligations and resections, 1 was application of a Yoon ring, and 4 were bilateral salpingectomies. Reasons for reversal requests were change of partner in 16 of 25 cases, death of an infant in 1 case, fear of repudiation by the husband in the cases of 4 Muslim women, and change of mind by the couple in 4 cases. 6 of the 25 women were unacceptable candidates for reversal, 4 because of bilateral salpingectomy and 2 because of poor tubal state and failure of previous surgery. 17 women underwent tubotubal anastomoses and 2 had tubouterine reimplantations. The reversal operations resulted in 12 term pregnancies, 1 spontaneous abortion, and 1 extrauterine pregnancy. The delays to pregnancy ranged from 1 to 18 months and averaged 6.6 months. The intrauterine pregnancy rate was 83% for reversals within 5 years of sterilization and 61% later. Age of the woman appeared to play no role. The postpartum period does not seem to be an ideal moment for sterilization because of its association with later requests for reversal. Several factors seem to be involved in requests for reversal, including young age at sterilization, the unpredictability of death in small children, and haste in making the initial sterilization decision. The policy of automatically recommending sterilization after a 3rd cesarean section should be reviewed since in many cases a successful delivery is still possible. Factors in successful reversal include the length of tube remaining, which is related to the sterilization technique employed, and the site of the sterilization, with ligations at the cornu and fimbriectomies giving poor results. The least mutilating forms of sterilization should be used in young women. Clips, rings, and ligations using absorbable thread with limited resection of the isthmus are reliable methods which have the advantage of not definitively compromising fertility. They can also be done by a simple laparoscopic procedure after the postpartum period.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12268400&dopt=Abstract

Adv Contracept Deliv Syst. 1987;3(2-3):181.
Antifertility treating with long term gossypol.

Xian SC, Wu ZE, Wuhan Tsong SD, Tung DS.

PIP: In the 1974-86 period, gossypol acetate was taken as an antifertility measure by 16 men. The initial dose was 20 mg/day, with a maintenance dose of 40 mg/week. Antifertility efficacy was obtained in all 16 cases. Azoospermia persisted in 1 case where the gossypol had been taken for 8 years and discontinued for the past 2 1/2 years. Symptoms experienced in the first 2 weeks of gossypol acetate administration included dizziness, anorexia, nausea, fatigue, and stomach discomfort. Results of examinations of blood and urine; functions of the heart, liver, lung, and liver; electrolytes; external genitalia; and sexual performance were all in the normal range. Measurements of semen, plasma biochemistry, and endocrine changes also were within normal limits. However, in the 9 cases in which the average value of plasma testosterone was near the lower limit of normal, the average value of follicle-stimulating hormone was higher than normal and the testosterone/luteinizing hormone ratio was unusually low. Testis biopsy indicated that long-term gossypol treatment affected both germ cells and Sertoli cells. Leydig cells also demonstrated some damage. Gossypol acetate is, in general, considered an ideal male contraceptive because of its long-term effectiveness, reversibility, and lack of severe toxic side effects.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12268655&dopt=Abstract

The most ostensive feature that distinguishes us human from chimps and other primates is the lack of bodily hair. During evolutionary process, we have lost the majority of hair. Hair is no longer an essential part of our body, just like appendix. What little hair we still have on our scalp and a few other bodily parts is still regarded as significant for reasons other than biological necessity. Hair loss is naturally accompanied by aging process, although the extent of hair loss and the timing of onset vary widely among individuals. Thus, loss of hair and baldness is considered as a symbol of maturity or old age. Like winkles and other signs of aging, hair loss is not welcome by most people, because we don't welcome aging, and being perceived as an aging person. However, it is alopecia, or premature hair loss that especially concerns certain people.

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