1.  Peer Reviewed Title: Fetal and early postnatal environmental exposures and reproductive health effects in the female. Author: Woodruff TK; Walker CL Source: Fertility and Sterility. 2008 Feb;89(2 Suppl 1):e47-e51. Abstract: The environment influences not only the development of the reproductive system, but also impacts adult reproductive function. Environmental cues such as the light:dark cycle, caloric signals, and pheromones are integrated at the central nervous system and, in combination with endogenous endocrine and paracrine signals, create a permissive or nonpermissive environment for the initiation and maintenance of the normal reproductive cycle. On the other hand, exposure to environmental agents can have profound negative effects on the development and function of the reproductive tract. The developmental programming hypothesis proposes that at critical times during development, exposure of developing tissues to an adverse stimulus or insult can permanently reprogram normal physiologic responses, and so give rise to metabolic and hormonal disorders later in life. The female reproductive tract has been shown to be a target for developmental programming as a result of environmental hormone exposure. This short review presents current research into the role of the environment in normal female reproductive function and pathogenesis, specifically focusing on the ovary and uterus. (excerpt) Language: English Keywords: TEXAS | LITERATURE REVIEW | CLINICAL RESEARCH | FETUS | PREGNANT WOMEN | WOMEN | ENVIRONMENT | TOXICITY | OVARIAN EFFECTS | FOLLICLE STIMULATING HORMONE | ESTROGENS | UTERUS | DIETHYLSTILBESTROL | REPRODUCTIVE HEALTH | POSTPARTUM | United States of America | North America | Americas | Developed Countries | Research Methodology | Pregnancy | Reproduction | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Ovary | Genitalia, Female | Genitalia | Urogenital System | Gonadotropins, Pituitary | Gonadotropins | Hormones | Endocrine System | Health | Puerperium Document Number: 325258 |
| 2. Peer Reviewed Title: Findings in female offspring of women exposed in utero to diethylstilbestrol. Author: Kaufman RH; Adam E Source: Obstetrics and Gynecology. 2002 Feb;99(2):197-200. Abstract: OBJECTIVE: To examine a group of women (third-generation daughters) whose mothers were exposed in utero to diethylstilbestrol (DES) and compare their findings on pelvic examination with those noted in their mothers. METHODS: Letters were mailed to women documented to have been exposed in utero to DES who had given birth to a female offspring, inviting them to have their daughters come in for a detailed history and pelvic examination. Records of the mothers whose daughters appeared for examination were reviewed, and findings noted at the time of their initial examination were recorded. Detailed pelvic examination of the third-generation daughters included colposcopic examination and iodine staining of the vagina and cervix and Papanicolaou smear. The findings observed in these women were compared with those noted in their mothers at the time of their mothers’ first examination. RESULTS: Twenty-eight third-generation daughters were examined. Three of the daughters were delivered from one mother. Review of the mothers’ records indicated that 16 (61.5%) of the mothers exposed to DES during their pregnancy demonstrated structural changes of the cervix, upper vagina, or vaginal epithelial changes consisting of adenosis, nonstaining vaginal epithelium after application of iodine solution, or white epithelium within the vagina. None of the daughters were found to have changes usually associated with DES exposure. CONCLUSION: The absence of abnormalities in the lower genital tract in third-generation women compared with the high frequency of these abnormalities in their mothers suggests that third-generation carryover effects of in utero DES exposure are unlikely. (author's) Language: English Keywords: MARYLAND | UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | DAUGHTERS | MOTHERS | DIETHYLSTILBESTROL | UTERUS | PELVIC EXAM | LABORATORY PROCEDURES | North America | Americas | Developed Countries | Studies | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Parents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Genitalia, Female | Genitalia | Urogenital System | Physical Examinations and Diagnoses | Examinations and Diagnoses | Laboratory Examinations and Diagnoses Document Number: 175284 |
3.  Title: Women exposed to DES in utero have elevated risks of fertility impairment and adverse pregnancy outcomes. Author: Hollander D Source: Family Planning Perspectives. 2001 Jan-Feb;33(1):43. Abstract: According to a study, women whose mothers took diethylstilbestrol (DES) during pregnancy are more likely than women who were not exposed to the drug in utero to experience delays in conceiving and are less likely ever to become pregnant. The study included 3373 women who were exposed to DES and 1036 unexposed controls who were enrolled in one of two longitudinal projects in the US. Three groups of women were compared: 1) women identified through review of medical records, 2) women referred to the project by a physician or self-referral, and 3) control group. These women completed a questionnaire that was mailed to them in 1994, asking about their health history, pregnancies and pregnancy outcomes. Data showed that DES-exposed women were significantly more likely than others to have had difficulty conceiving. The analysis of adverse outcomes in any pregnancy yielded similar results for both groups of women who were exposed to DES. Based on these findings, the researchers concluded that it is important for obstetrician-gynecologists to be aware of the consequences of DES exposure in utero on pregnancy outcome. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | DIETHYLSTILBESTROL | PREGNANCY OUTCOMES | SIDE EFFECTS | Developed Countries | North America | Americas | Estrogens | Hormones | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment Document Number: 155047 |
| 4. Title: Breast cancer epidemiology: summary and future directions. Author: Kelsey JL Source: EPIDEMIOLOGIC REVIEWS. 1993;15(1):256-63. Abstract: The most common cancer in US women and the 2nd leading cause of cancer death is breast cancer. Between 1980-1987 in the US. age-adjusted incidence rates of breast cancer rose rapidly. They are also rising rapidly in several Asian countries (e.g., in Japan) which have the lowest incidence rates. These rapid increases may mean that environmental factors are responsible. Incidence rates rise greatly with age until the late 40s. US women at highest risk of breast cancer are Jewish women, urban women, single women, and women living in the northern US. Women at lowest risk include Mormon and Seventh-Day Adventist women, Hispanic and Asian women, rural women, women living in the southern US, and married women. Factors that have a relative risk greater than 2 are mother and sister with history of breast cancer, especially if diagnoses at an early age; atypical epithelial cells in nipple aspirate fluid; nodular densities on the mammogram; history of cancer in 1 breast; mother or sister with history of breast cancer; biopsy-confirmed benign proliferative breast disease; hyperplastic epithelial cells without atypia in nipple aspirate fluid; and radiation to chest in moderate to high doses. Ovarian hormones appear to stimulate cell division in the breast, thus elevated levels may be risk factors. Exogenous hormones may also increase the risk. Women are exposed to these exogenous hormones through estrogen replacement therapy, progestin only pills, oral contraceptives, long-acting injectable contraceptives, and diethylstilbestrol. Postmenopausal obesity increases the risk while premenopausal obesity decreases the risk. A high fat diet in childhood and adolescence may increase the risk. Alcohol drinking may also increase the risk. Older, white, and nulliparous women are more likely to have estrogen receptor-positive cancers. Breast cancer in males tends to share the same risk factors as well as its own unique factors. Prevention of postmenopausal obesity is the only established primary prevention effort. Screening is the only secondary prevention means. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPED COUNTRIES | DEVELOPING COUNTRIES | BREAST CANCER | RISK FACTORS | BIOLOGY | GENETICS | REPRODUCTION | ESTROGENS | ESTRADIOL | PROGESTERONE | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, PROGESTIN | DIETHYLSTILBESTROL | OBESITY | BODY WEIGHT | DIET | ALCOHOL USE AND ABUSE | FIBROIDS | HORMONE RECEPTORS | TOBACCO USE | RELIGION | PREVENTION AND CONTROL | North America | Americas | Cancer | Neoplasms | Diseases | Hormones | Endocrine System | Physiology | Progestational Hormones | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents | Nutrition | Health | Behavior | Neoplasms, Benign | Membrane Proteins Document Number: 084713 |
| 5. Title: Diethylstilbestrol (DES) and breast cancer. Author: Malone KE Source: EPIDEMIOLOGIC REVIEWS. 1993;15(1):108-9. Abstract: It is estimated that 2 million US women used diethylstilbestrol (DES), a nonsteroidal estrogen, to reduce the risk of fetal loss from the late 1940s through the early 1960s. The results of clinical trials of the effectiveness of DES in the early 1950s precipitated the eventual decline of DES prescription by the 1960s. Concern about the breast cancer risk associated with the high dose of stilbestrol used led to 2 follow-up studies of these clinical trial participants, as well as 2 other retrospective cohort studies to examine the subsequent risk of breast cancer in DES-exposed women. 3 of the 4 studies reported positive results, with an overall 50% increase in risk for ever using DES during pregnancy and an apparent latency period of more than 20 years. These studies have or more limitations, including the absence of information on dosage taken and duration of use, confusion about the identify of the exposed group and the inability to distinguish between the effect of DES and the effect of indications for using DES. Nevertheless, the findings supported a possible association between DES and breast cancer risk. The 4 studies were published between 1980 and 1984 and included many women who had only recently entered the age period when breast cancer incidence is high. It is possible that the incidence of breast cancer associated with DES may increase with additional follow-up time. Prenatal influences on carcinogenesis have recently become of interest in the etiology of adult cancer, and, in particular, it has been proposed that increased estrogen levels during pregnancy might increase the probability of breast cancer in daughters. It has been demonstrated that DES use during pregnancy can influence the subsequent risk of clear cell adenocarcinoma in offspring, although the issue of whether DES might also influence the subsequent risk of breast cancer in daughters remains to be investigated. Language: English Keywords: UNITED STATES OF AMERICA | COHORT ANALYSIS | RETROSPECTIVE STUDIES | FOLLOW-UP STUDIES | DIETHYLSTILBESTROL | PREGNANT WOMEN | BREAST CANCER | DAUGHTERS | SIDE EFFECTS | Developed Countries | North America | Americas | Research Methodology | Studies | Estrogens | Hormones | Endocrine System | Physiology | Biology | Population Characteristics | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Family Relationships | Family Characteristics | Family and Household | Treatment Document Number: 084712 |
| 6. Title: Postcoital contraception underrecognized and underutilized. Author: DeMarco JJ Source: FEMALE PATIENT. 1992 Jun;17(6):24, 26. Abstract: Postcoital contraception can play an important role in the prevention of unwanted adolescent pregnancy in the US. Diethylstilbestrol (DES), 25 mg twice daily for 5 days within 24 to a maximum of 72 hours after unprotected sexual intercourse, received US Food and Drug Administration (FDA) approval for pregnancy prevention in 1973. In 1978, however, the manufacturer, Eli Lilly, included in its packaging instructions that DES should not be used for postcoital contraception given the development of clear-cell adenocarcinoma of the vagina or cervix in the daughters of women who took DES to prevent spontaneous abortion. The FDA had not withdrawn its approval of DES for this purpose. Other drugs that have been effectively used for postcoital contraception include 0.5 mg of norgestrel and 0.05 mg of ethinyl estradiol (2 tablets within 72 hours of unprotected intercourse and another 2 tablets 12 hours later) and conjugated estrogens. This approach to pregnancy prevention sidesteps many of the medical and moral complexities associated with use of the abortifacient RU-486. In fact, the Catholic bishops of Great Britain have approved the use of postcoital contraception in women who are victims of sexual assault. Language: English Keywords: UNITED STATES OF AMERICA | ADOLESCENT PREGNANCY | RAPE | DIETHYLSTILBESTROL | CONTRACEPTIVE AGENTS, POSTCOITAL | CATHOLICISM | EMERGENCY CONTRACEPTION | Developed Countries | North America | Americas | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Crime | Social Problems | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Christianity | Religion Document Number: 097501 |
| 7. Title: The role of the expanded function nurse in fertility preservation. Author: Keating CE Source: NAACOGS CLINICAL ISSUES IN PERINATAL AND WOMENS HEALTH NURSING. 1992;3(2):293-300. Abstract: The role of the nurse needs to be expanded to include protection of women's reproductive potential. Nursing has adjusted to the change in medical care through assistance in regaining of health in acute and extended care facilities, in health maintenance, and in acting as primary care providers in providing information on prevention. Infertility increases with age. The impact of contraceptive choices on fertility is reviewed for barrier contraception, oral contraception, IUDs, sterilization, and new contraceptive methods. At different stages in the life cycle there are methods of contraception that are more appropriate than others. The environmental effects on fertility are noted for diethylstilbestrol (DES), which may result in cell carcinoma and changes in the cervical ectropion, uterine, and tubal anomalies; these effects in turn may lead to decreased fertility or fetal loss. DES may also affect male fertility. Chemicals in the workplace such as lead, ionizing radiation, ethylene oxide, and dibromochloropropane are Federally regulated because of deleterious effects on reproduction. Other metals and chemicals that may affect fertility are indicated. The prevention of sexually transmitted diseases has a significant impact on preservation of fertility. Life style choices and counseling at early stages of disease are important considerations. Women who smoke have an earlier menopause, have reduced estrogen levels, and increased vaginal bleeding. Infant mortality is higher among women who smoke. Fetal alcohol syndrome is known, but alcohol's effect on fertility is not well documented. Adolescent drug use may lead to later dysfunction. Marijuana use in adults has been related to decreased levels of follicle stimulating hormone, luteinizing hormone, and prolactin, which appears to be reversible in adults. Exposure to high levels of heat is related to male infertility (sperm quality and number); increased scrotal temperature may be caused by febrile illness, varicocele, hot tub usage, and tight jockey shorts. Fertility impairment may be related to a previous medical or surgical intervention. Options are available for organ preservation rather than outright removal. General health conditions related to infertility are identified. The nurse practitioner as a preconception counselor may screen for potential infertility and collect a routine history and physical examination including testing. Language: English Keywords: CRITIQUE | NURSES AND NURSING | INFERTILITY | AGE FACTORS | CONTRACEPTIVE METHODS CHOSEN | BARRIER METHODS | ORAL CONTRACEPTIVES | IUD | FEMALE STERILIZATION | HEALTH EDUCATION | REPRODUCTIVE HEALTH | CONTRACEPTION RESEARCH | ENVIRONMENTAL POLLUTION | LEAD | DIETHYLSTILBESTROL | LIFE STYLE | ALCOHOL USE AND ABUSE | SEXUALLY TRANSMITTED DISEASES | TOBACCO USE | DRUG USE AND ABUSE | OBSTETRICAL SURGERY | CLIENT-STAFF RELATIONS | INORGANIC CHEMICALS | Health Personnel | Delivery of Health Care | Health | Reproduction | Population Characteristics | Demographic Factors | Population | Contraceptive Usage | Contraception | Family Planning | Contraceptive Methods | Sterilization, Sexual | Education | Environmental Degradation | Environment | Metals | Vitamins and Minerals | Physiology | Biology | Estrogens | Hormones | Endocrine System | Behavior | Reproductive Tract Infections | Infections | Diseases | Surgery | Treatment | Interpersonal Relations | Ingredients and Chemicals Document Number: 076323 |
| 8. Title: DES exposure: implications for childbearing. Author: Milhan D Source: INTERNATIONAL JOURNAL OF CHILDBIRTH EDUCATION. 1992 Nov-Dec;7(4):21-8. Abstract: From the 1940s to the early 1970s, diethylstilbestrol (DES), an oral, nonsteroidal synthetic estrogen, was prescribed by physicians to 2-6 million women in the US alone to prevent miscarriages. In 1970, and article documented the correlation between in utero DES exposure and development of a rare vaginal cancer, clear-cell adenocarcinoma. In 1971, US Federal Drug Administration banned the drug from use during pregnancy. Since then, controlled studies have proven that administration of DES was associated with increased spontaneous abortions, premature delivery, complications during delivery, and neonatal deaths. DES-exposed daughters in reproductive age faced increased rates of infertility, spontaneous abortion, ectopic pregnancy, and premature delivery. DES-exposed daughters may suffer more pelvic inflammatory disease and dysmenorrhea. A 1988 study related the infertility experience of 796 daughters born to mothers who took part in a double-blind, controlled study of DES use during pregnancy at a Chicago hospital in 1951 and 1952. In early 1986, primary infertility was reported by 33% of the DES-exposed daughters as opposed to 14% of the unexposed subjects. However, 81% of pregnant DES daughters have at least one full-term live birth. Uterine abnormalities including a T-shaped or hypoplastic cavity, a septate uterus, intrauterine adhesions, or irregular uterine margins were documented in 46% of the DES-exposed daughters with primary infertility. Vaginal adenosis is reported to occur in 30%-90% of DES-exposed daughters. Cervical hypoplasia and shortened cervical structure are the primary cervical abnormalities. In addition, for 10 years researchers have observed certain alterations in the immune systems of DES-exposed women. Most physicians recommend alternative birth control methods to oral contraceptives to avoid an additional exposure to synthetic estrogens. Language: English Keywords: UNITED STATES OF AMERICA | DIETHYLSTILBESTROL | VAGINAL CANCER | ABORTION, SPONTANEOUS | LITIGATION | INFERTILITY | PREMATURE BIRTH | UTERINE EFFECTS | CERVICAL EFFECTS | TUBAL EFFECTS | IMMUNOLOGICAL EFFECTS | PREGNANCY, ECTOPIC | PREGNANCY OUTCOMES | SIDE EFFECTS | Developed Countries | North America | Americas | Estrogens | Hormones | Endocrine System | Physiology | Biology | Cancer | Neoplasms | Diseases | Pregnancy Complications | Reproduction | Pregnancy | Uterus | Genitalia, Female | Genitalia | Urogenital System | Cervix | Fallopian Tubes | Immunity | Immune System | Treatment Document Number: 083786 |
| 9. Title: Vasectomy and testicular cancer. No association on current evidence [editorial] Author: West RR Source: BMJ. British Medical Journal. 1992 Mar 21;304(6829):729-30. Abstract: In 1985, the number of registrations of testicular cancer cases in England and Wales was 922, but incidence may be growing. Death rates are not growing, however. The case fatality rate ranges between 10-15%. Testicular cancer incidence peaks between 25-29 years. Identified risk factors include undescended testis, trauma, and exposure to stilbestrol in utero. 1 hypothesis has emerged as to why testicular cancer incidence is growing: tight slacks or underwear increasing testicular temperature. Several studies have investigated its association with vasectomy. In fact, the number of vasectomies are increasing in national health system hospitals and private clinics in the UK. UK physicians perform >45,000 vasectomies annually. A study in Ireland and another in Scotland find vasectomy has an increased risk of testicular cancer (relative risk [RR] 3.7 and 4.2 respectively), but the 95% confidence intervals are very wide (0.8-11 and 1.8-8.2 respectively). 1 English and 2 US case control studies report odds ratios of 1.1, 0.6, and 1.5 respectively. On the other hand, a cohort study in Oxford, England reveals vasectomy to have a likely reduced risk (RR=0.5). A problem with all these studies is that the numbers are small due to the rarity of testicular cancer. Other limitations of the Oxford study include it is based on hospital admissions and not cancer registration and the investigators did not mention history of genitourinary disease and stilbestrol in utero and other confounding factors. When one considers all the studies, it appears that little association exists between testicular cancer and vasectomy. Nevertheless investigators should follow other cohorts of men who had vasectomies and restudy them specifically for testicular cancer. Further they should initiate new case control studies. Language: English Keywords: UNITED KINGDOM | WALES | IRELAND | SCOTLAND | UNITED STATES OF AMERICA | CRITIQUE | CANCER | TESTIS | RISK FACTORS | VASECTOMY | DIETHYLSTILBESTROL | BODY TEMPERATURE | INCIDENCE | COMPLICATIONS | United Kingdom | Europe, Western | Europe | Developed Countries | North America | Americas | Neoplasms | Diseases | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Male Sterilization | Sterilization, Sexual | Family Planning | Estrogens | Hormones | Endocrine System | Measurement | Research Methodology Document Number: 071634 |
| 10. Title: Must a Catholic hospital inform a rape victim of the availability of the "morning-after pill"? Author: Brushwood DB Source: AMERICAN JOURNAL OF HOSPITAL PHARMACY. 1990 Feb;47(2):395-6. Abstract: The California Court of Appeals discussed in Brownfield v. Daniel Freeman Memorial Hospital, 256 Cal. Rptr. (1989), whether a health-care giver must inform a patient of medical options that the care-giver morally opposes. In this case, workers in a Catholic hospital refused to inform a rape victim about the "morning-after pill" (diethylstilbestrol) despite the victim's mother requesting the information, the possibility of a pregnancy, and the need for treatment within 72 hours, because such information conflicted with the institutions' religious beliefs. The plaintiff did not become pregnant, and the court dismissed the case because there was no compensable injury; the plaintiff did not appeal the dismissal. The court agreed with the plaintiff that the "morning-after" pill is postcoital contraception (like the IUD), not an abortifacient, since the fertilized ovum has not yet become implanted in the uterine mucosa (nidation). In reviewing the California Therapeutic Abortion Act the court said that while religious facilities need not perform abortions, the statute does not apply to medical emergencies or spontaneous abortions. The court stated that a patient has the right to self-determination in his or her treatment, superseding the moral and religious convictions of the hospital, and that medical malpractice would exist in cases where "damages have proximately resulted from the failure to provide [a patient] with information concerning...treatment option[s]," when "a skilled practitioner of good standing would have provided her with information...under similar circumstances," and "that if such information had been provided to her, she would have elected such treatment." The court found no duty to provide non emergency treatment, only a duty to inform the patient about treatment options. Language: English Keywords: CALIFORNIA | CONTRACEPTIVE AVAILABILITY | IMPLANTATION SUPPRESSION | INFORMED CONSENT | PHYSICIAN-PATIENT RELATIONS | UNITED STATES OF AMERICA | CONTRACEPTIVE AGENTS, POSTCOITAL | SOCIAL POLICY | ABORTION LAW | ABORTION | DIETHYLSTILBESTROL | CATHOLICISM | EMERGENCY CONTRACEPTION | RELIGIOUS ASPECTS | Developed Countries | North America | Americas | Contraception | Family Planning | Contraceptive Mode of Action | Interpersonal Relations | Behavior | Contraceptive Agents, Female | Contraceptive Agents | Policy | Fertility Control, Postconception | Estrogens | Hormones | Endocrine System | Physiology | Biology | Christianity | Religion Document Number: 074865 Notification |
| 11. Title: [Responsibility of diethylstilbestrol administered during pregnancy in the testicular feminization syndrome] Prise de diethylstilbestrol pendant la grossesse. Sa responsabilite dans le syndrome du testicule feminisant. Author: Chryssicopoulos A; Kondi-Parhitis A; Kairi D; Vasiliadis T; Maragoudakis A Source: PRESSE MEDICALE. 1990 Sep 22;19(30):1397-400. Abstract: Individuals suffering from complete insensitivity to androgens or the testicular feminization syndrome (TFS) have feminine phenotypes bu masculine internal genital organs. 2 cases are described of TFS with incomplete regression of the Mullerian ducts in young women whose mothers had taken diethylstilbestrol (DES) in the 1st 2 months of pregnancy. The 2 women, 18 and 19 years old, appeared normal and well developed but reported primary amenorrhea. At laparotomy, masses were removed which microscopically resembled and were histologically confirmed to be testes and Fallopian tubes. TFS is known to be the result of a mutation linked to the X chromosome, which suppresses the normal synthesis of androgen receptors. Such genetic abnormalities can be explained by insufficient secretion of antimullerian hormone or by an early descent of testicles with regression of the Mullerian ducts beyond the range of antimullerian hormone. The most likely cause is the 2 cases described was intrauterine exposure to DES early in pregnancy. The mother of 1 of the patients received 2400 mg of DES between the 3rd and 9th week of pregnancy and the other received 1450 mg between the 3rd and 12th week, both to prevent miscarriage. Language: French Keywords: GREECE | DIETHYLSTILBESTROL | SEX DETERMINATION | UROGENITAL EFFECTS | CHROMOSOME ABNORMALITIES | UROGENITAL SYSTEM | CONGENITAL ABNORMALITIES | EMBRYO | PREGNANCY, FIRST TRIMESTER | EXAMINATIONS AND DIAGNOSES | COMPLICATIONS | Developed Countries | Europe, Southern | Europe | Estrogens | Hormones | Endocrine System | Physiology | Biology | Genetic Techniques | Laboratory Examinations and Diagnoses | Neonatal Diseases and Abnormalities | Diseases | Pregnancy | Reproduction Document Number: 065717 |
| 12. Title: Post-ovulatory contraception. Author: Glasier A; Baird DT Source: BAILLIERES CLINICAL OBSTETRICS AND GYNAECOLOGY. 1990 Jun;4(2):283-91. Abstract: The methods known to be practical for post-ovulatory contraception, defined as any substance or device used after coitus to prevent establishment of pregnancy up to 14 days after ovulation are reviewed. Most are used only in emergency for a single episode of unprotected intercourse or failed contraception, exceptions being the "visiting pill" of norethindrone used for migrant workers in China, and the IUD when inserted for this purpose as well as ongoing contraception. The physiology of ovulation, fertilization, transport of the ovum, and implantation of the blastocyst are reviewed. Estimates of the odds of becoming pregnant after an isolated unprotected intercourse range from 10-25%. High-dose estrogens, either stilbestrol (no longer used in the U.S.), ethinyl estradiol 5 mg, or conjugated estrogens 30 mg, have been used since early trials in the 1960s. Estrogen must be given for 5 days, started within 72 hours of coitus, and cause several unpleasant side effects, notably nausea, vomiting, mastalgia, and menstrual irregularity. Although no incidents have been reported, they are contraindicated for those at risk of thromboembolism. The failure rate is about 0.7%. Combined estrogen and progestagen, known as the Yuzpe method, consists of 2 dose of 100 mcg ethinyl estradiol and 1 mg norgestrel, repeated in 12 hours. The reported failure rates range from 0.2%-7.4%. Insertion of a copper IUD is effective post-coitally within 66 days, with failure rate less than 0.1%. The antiestrogen Danazol, which actually acts as an antigonadotrophin, can be used as a postcoital agent, in divided doses of 800 or 1200 mg 12 hours apart within 72 hours of exposure. Published failure rates are 2.5 and 0.9% with these doses. Progestagens alone have been studied by WHO, but failure rates were as high as 10.1% in women with frequent intercourse. Regular use was not recommended since cycles became unpredictable. Studies are being conducted on RU-486 and prostaglandins for postcoital use, in comparison with the Yuzpe regimen. A true luteolytic agent for women would seem to be the perfect postcoital agent, yet none exist. Language: English Keywords: LITERATURE REVIEW | CONTRACEPTIVE AGENTS, POSTCOITAL | LEVONORGESTREL | CONTRACEPTIVE AGENTS, PROGESTIN | NORETHINDRONE | ETHINYL ESTRADIOL | CONTRACEPTIVE EFFECTIVENESS | ORAL CONTRACEPTIVES, COMBINED | IUD, COPPER RELEASING | DIETHYLSTILBESTROL | CONJUGATED ESTROGENIC SUBSTANCES | ESTRADIOL | RU-486 | HORMONE ANTAGONISTS | PROSTAGLANDINS, SYNTHETIC | CONTRACEPTIVE MODE OF ACTION | OVULATION SUPPRESSION | IMPLANTATION SUPPRESSION | LUTEOLYTIC EFFECTS | COITAL FREQUENCY | EMERGENCY CONTRACEPTION | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Agents, Estrogen | Oral Contraceptives | Contraceptive Methods | IUD | Estrogens | Hormones | Endocrine System | Physiology | Biology | Prostaglandins | Corpus Luteum | Ovary | Genitalia, Female | Genitalia | Urogenital System | Sex Behavior | Behavior Document Number: 065098 |
| 13. Title: [The significance of postcoital hormonal contraception for prevention of conception] Die Bedeutung der postkoitalen hormonalen Kontrazeption fur die Empfangnisverhutung. Author: Kohler G Source: ZEITSCHRIFT FUR ARZTLICHE FORTBILDUNG. 1990;84(1-2):21-4. Abstract: High-dose estrogens taken no later than 72 hours after coitus came into use in the mid-1970's. 25 mg and 50 mg diethylstilbestrol, .5-5 mg ethinyl estradiol (EE), or 20-30 mg conjugated estrogens taken daily for 3-5 days, however, produced frequent side effects: nausea in 54%, vomiting in 24%, and mastodynia in 23%. In the mid-1970's estrogen-gestagen combination methods appeared: 2 single doses of .1 mg EE and .5 mg levonorgestrel (LNG) taken 12 hours apart still resulted in a fairly high rate of adverse effects. .4 mg to .75 mg of LNG taken 1 hour (at the latest, 8 hours) after coitus produced fewer side effects, mostly increased bleeding, and menstrual disorders. The mechanism of action of these preparations lies in the inhibition of ovulation, and in corpus luteum insufficiency of the hypothalamic-hypophysic-ovarial axis. The teratogenic risk of a fetus carried to term after failure of postcoital contraception is minimal or nonexistent. 2 mg dienogest (DNG) taken immediately after coitus produced 14 pregnancies corresponding to a 55.6 Pearl Index (PI) rate over 302 menstrual cycles and 872 instances of coitus i.e., a pregnancy rate of 1.6%. The expected number of pregnancies normally would have been 35.3, or a rate of 4%. The failure rate was 5.1%. .4 mg LNG produced a PI of 3.5 and .75 mg LNG resulted in a PI of 3.3. .75 mg LNG taken 5 times during the cycle produced a PI of 10.6 vs. a PI of 2.5 to 4.3 after daily single doses of .03 mg of LNG and a PI of O to 3.6 after taking .05 mg d,l-norgestrel. The failure rate of the EE/LNG combination was 1.6% based on 692 instances of coitus, the same as with DNG. The expected number of pregnancies was 31.8 vs. 11 that actually occurred, thus the risk of pregnancy was lowered by a factor of 2.8. These methods are recommended after unprotected sex, or after rape. Language: German Keywords: CONTRACEPTIVE AGENTS, POSTCOITAL | ETHINYL ESTRADIOL | LEVONORGESTREL | CONTRACEPTIVE MODE OF ACTION | DIETHYLSTILBESTROL | PEARL'S FORMULA | FERTILITY CONTROL, POSTCOITAL | EMERGENCY CONTRACEPTION | ADMINISTRATION AND DOSAGE | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Agents, Estrogen | Contraceptive Agents, Progestin | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Use-Effectiveness | Contraceptive Effectiveness | Drugs | Treatment Document Number: 062898 |
| 14. Title: [Hydranencephaly and estrogen intake during pregnancy. Fetal cerebral vascular complication?] Hydranencephalie et prise d'oestrogenes pendant la grossesse. Accident vasculaire cerebral foetal? Author: Blanc JF; Lapillonne A; Pouillaude JM; Badinand N Source: ARCHIVES FRANCAISES DE PEDIATRIE. 1988 Aug-Sep;45(7):483-5. Abstract: A case is described of hydranencephaly probably resulting from massive maternal intake of estrogen in the 18th week of pregnancy. Hydranencephaly is defined as the absence or near absence of cerebral hemispheres in an almost normal cranial area. It is a destructive prenatal encephalopathy caused by an anomaly of cerebral development following circulatory disturbances. Numerous causes have been suggested. In this case, the pregnancy occurred while the mother was on oral contraceptives. Around the 18th week, for unknown reasons, the mother took a dose of diethylstilbestrol amounting to 50 mg/day for 5 days. The mother smoked 20 cigarettes daily through the 20th week and 12 a day thereafter. Metrorrhagia appeared 48 hours after the estrogen intake, heavy at 1st and intermittent thereafter until the end of the pregnancy. A sonogram at the time of appearance of metrorrhagia was considered normal, but another 4 weeks later showed apparent anomalies. The baby was delivered at 36 weeks and initially appeared healthy, with an Apgar score of 10 and a normal neurological examination. Various problems in the 1st week prompted an electroencephalogram at 6 days, which was abnormal. The diagnosis of hydranencephaly was made on the basis of a transfontanellar sonogram. No evidence of fetal exposure to rubeola, toxoplasmosis, or other infectious agent was found, and the karyotype was normal. Slight neurological disturbances became more obvious in the 2nd month. The infant died at 4 months. The teratogenic effects of estrogen have not been conclusively proven. The risk of vascular accident is increased by smoking. It is probable that the combined effect of maternal smoking and massive administration of synthetic estrogens induced vascular lesions at the level of the fetal cerebral arteries or of placental vessels, causing decreased placental blood exchanges and decreased fetal cerebral blood supply. Whatever the mechanism, the estrogen very likely induced an acute fetal cerebral vascular accident. Language: French Keywords: FRANCE | DIETHYLSTILBESTROL | PREGNANCY, SECOND TRIMESTER | CONGENITAL ABNORMALITIES | TOBACCO USE | EXAMINATIONS AND DIAGNOSES | CEREBROVASCULAR EFFECTS | FETUS | SIDE EFFECTS | Europe, Western | Europe | Developed Countries | Estrogens | Hormones | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Neonatal Diseases and Abnormalities | Diseases | Behavior | Treatment Document Number: 058066 |
| 15. Title: Contraception for women exposed in utero to diethylstilbestrol. Author: Edelman DA; Badrawi HH Source: ADVANCES IN CONTRACEPTION. 1988 Sep;4(3):241-6. Abstract: A brief review of the consequences of exposure to diethylstilbestrol (DES) in utero is provided to explain recommendations of contraceptive measures for the estimated 185,000-1,390,000 U.S. women exposed. The drug was prescribed from 1947-1971, affecting about 0.4-3.0% of the 97 million persons born in the period, who are 17-41 years old today. Some of the effects of DES that may have a bearing on contraceptive choices are uterine malformation, most frequently a T-shaped uterus, and epithelial changes in the cervix and vagina. Vaginal adenosis is a benign condition occurring in 11-96% of the exposed. Cervical ectropion has been reported in 23-90%. Uterine abnormalities include abnormal hysterosalpingograms, with wide lower segment, hypoplastic, or constricted uterus. These usually contraindicate the use of an IUD, but if the uterus is normal and an appropriate size of IUD is available, there is no known reason not to use an IUD. Generally, DES exposure causes a higher risk of ectopic pregnancy, spontaneous abortion, and premature delivery. Possibly, a pregnancy with an IUD in place would confer a higher risk of ectopic pregnancy for DES exposed women. Vaginal spermicides may even be beneficial to women with vaginal adenosis, which is treated with acidification. Use of oral contraceptives by DES-exposed women is problematical, because the cervical and vaginal cancers that they develop have not been studied in of oral contraceptive users. DES increases the incidence of clear-cell cancer of the vagina and cervix, while pills protect against ovarian and endometrial cancer, and benign breast tumors and ovarian cysts. Tubal sterilization is not contraindicated for DES-exposed women. Language: English Keywords: UNITED STATES OF AMERICA | ORAL CONTRACEPTIVES | SPERMICIDAL CONTRACEPTIVE AGENTS | IUD | DIETHYLSTILBESTROL | TUBAL OCCLUSION | CERVICAL EFFECTS | UTERINE EFFECTS | CERVICAL CANCER | VAGINAL CANCER | VAGINAL ABNORMALITIES | RISK FACTORS | PREGNANCY, ECTOPIC | CONTRACEPTIVE METHODS CHOSEN | CONTRACEPTION | SIDE EFFECTS | Developed Countries | North America | Americas | Contraceptive Methods | Family Planning | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Female Sterilization | Sterilization, Sexual | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Cancer | Neoplasms | Diseases | Pregnancy Complications | Contraceptive Usage | Treatment Document Number: 052504 |
| 16. Title: Post-coital interception. Author: Haspels AA Source: In: Female contraception: update and trends, edited by B. Runnebaum, T. Rabe, L. Kiesel. Berlin, Germany, Federal Republic of, Springer-Verlag, 1988. :371-80. Abstract: Postcoital contraception (PCC) in women was developed in the 1960s in the United States using diethylstilbestrol and in Europe using ethinyl estradiol in high doses. In humans, once the ovum is implanted, the administration of large doses of estrogens does not interfere with pregnancy; however, such large doses shortly after unprotected intercourse are highly effective in preventing pregnancy. In a 1976 study involving 3016 women these side effects were reported: nausea in 54%, vomiting in 24%, tender breasts in 23%, and menorrhagia in 11%. Several hypotheses are proposed concerning the mechanisms of action. Thromboembolism could be expected from the high dosages of estrogens used but has not been reported except for a case of nonfatal pulmonary edema. A recent postcoital contraceptive combination of high efficacy was originally advocated by Yuzpe and entailed the administration of 50 mcg of ethinyl estradiol and 250 mcg of levonorgestrel given in a dose of two pills immediately and two tables 12 hours later. The postcoital use of an IUD to prevent pregnancy can be used as an alternative method more than 72 hours after intercourse. However, IUD insertion can produce serious complications if the patient has a vaginal or venereal infection, an asymptomatic cervicitis, or pelvic inflammatory disease. The potential risk of infertility should also be considered, since PID rate in nulliparous IUD users are 7 times higher than in nonusers. The high efficacy of the postcoital copper IUD may be caused by the high embryotoxic copper ion concentration in the uterus during the 1st month after insertion. Recent development in PCC include drugs that interfere with the normal physiology of early embryonic development and implantation, such as clomiphene, tamoxiphen, anordrin, and anordrin analogues. The antiprogestin, RU-486, is also promising as a morning-after pill for emergency use from day 27-30 in a dosage of 100 mg daily. Postcoital interception has a definite place in family planning and fertility regulation. Language: English Keywords: LITERATURE REVIEW | FERTILITY CONTROL, POSTCOITAL | DIETHYLSTILBESTROL | ETHINYL ESTRADIOL | ESTROGENS | LEVONORGESTREL | IUD, COPPER RELEASING | RU-486 | EMERGENCY CONTRACEPTION | ADMINISTRATION AND DOSAGE | Family Planning | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Contraceptive Agents, Progestin | IUD | Contraceptive Methods | Hormone Antagonists | Drugs | Treatment Document Number: 108453 |
| 17. Title: Breast cancer epidemiology. Author: Kelsey JL; Berkowitz GS Source: CANCER RESEARCH. 1988 Oct 15;48(20):5615-23. Abstract: The various risk factors for breast cancer have been recognized for many years. A table lists these established breast cancer risk factors together with the approximate magnitude of the increase in risk associated with them. Breast cancer incidence rates increase with age throughout the life span in Western countries, although the rate of increase is greater up to age 50 years than after 50 years. Breast cancer is more common among women in upper rather than lower social classes, among women who never have been married, among women living in urban areas, among women living in the northern US than in the southern US, and among whites than blacks, at least among those over age 50. Women in North American and Northern European countries have the highest risk for breast cancer, women in Southern European and Latin American countries are at intermediate risk, and women in Africa and Asian countries have the lowest risk. Yet, rapid rates of increase in incident rates have been noted in recent years in many Asian, Central European, and some South American countries. The later the age at which a woman has her 1st full-term pregnancy, the higher her risk for breast cancer; the earlier the age at menarche and the later the age at menopause the higher the risk; and among women who have a premenopausal oophorectomy, the earlier the age at which this occurs the lower the risk. Among postmenopausal women, obesity is associated with an increase in risk. Lactation is negatively associated with subsequent breast cancer risk. Some current research is considering potential risk factors that have not been well studied in the past, including alcohol consumption, cigarette smoking, caffeine consumption, exposure to diethylstilbestrol (DES), emotional stress, exposure to electric power, and lack of physical activity. Other areas of current research reviewed here include radiation, mammographic parenchymal patterns, a high-fat diet, use of oral contraceptives (OCs), use of estrogen replacement therapy, and endogenous hormones. Cigarette smoking and caffeine consumption do not appear promising as potential etiologic agents. The studies of the DES-exposed women and of OC users suggest that the timing of exposure may be critical, since the possible effect of both these hormonal agents may be limited to specific time periods of rapid breast development. If such a critical period does not exist in postmenopausal women, then there may be little effect of hormones used at this time. Studies with long-term follow-up and that include long-term users are essential to studies of effects of hormones and other exposures. Language: English Keywords: BREAST CANCER | CANCER | NEOPLASMS | DISEASES | INCIDENCE | MEASUREMENT | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | FAMILY PLANNING | ESTROGENS | HORMONES | REPRODUCTIVE CONTROL AGENTS | DIETHYLSTILBESTROL | ALCOHOL USE AND ABUSE | LITERATURE REVIEW | SIDE EFFECTS | CONTRACEPTIVE METHODS | Research Methodology | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Endocrine System | Physiology | Biology | Behavior | Treatment Document Number: 055561 |
| 18. Peer Reviewed Title: Hormonal factors and risk of ovarian germ cell cancer in young women. Author: Walker AH; Ross RK; Haile RW; Henderson BE Source: BRITISH JOURNAL OF CANCER. 1988 Apr;57(4):418-22. Abstract: No previous controlled studies of ovarian germ cell tumors have been reported; however, the tumor is similar to germ cell testicular cancer in terms of histology, age-specific incidence rates (i.e., highest rates in young adulthood), and secular trends of increasing incidence. The investigation was designed to determine if maternal hormonal factors which have been found to increase the risk of testis cancer in male offspring are also risk factors for the ovarian tumor. The analysis is based on 73 cases diagnosed before age 35 and 138 age-race matched controls. The cases were identified by tumor registries in Los Angeles (1972-84) and Seattle (1974-84) and controls were selected from friends and/or neighborhood residents. Interviews were conducted on the telephone with mothers of cases and controls. The primary finding was that mother's use of exogenous hormones (including the hormonal pregnancy test, DES, or other supportive hormones, and inadvertent use of oral contraceptives after conception) increased risk (odds ratio, OR=3.60, 95% CL=1.2-13.1). Other maternal factors associated with elevated risk were high prepregnancy body mass (OR=2.7, 95% CL=1.0-7.6), more rapid achievement of regular menstruation after menarche (OR=1.8, 95% CL=0.9-3.8), and age at index pregnancy under 20 (OR=2.8, 95% CL=1.0-10.7). In conclusion, these results support findings from testis cancer studies regarding a hormonal etiology for germ cell tumors, and a mechanism by which estrogen may affect the germ cells is proposed. (author's) Language: English Keywords: OVARIAN CANCER | CANCER | NEOPLASMS | DISEASES | GERM CELLS | GENITALIA | UROGENITAL SYSTEM | PHYSIOLOGY | HORMONES | REPRODUCTIVE CONTROL AGENTS | HISTOLOGY | CONTROL GROUPS | RESEARCH METHODOLOGY | DATA COLLECTION | DIETHYLSTILBESTROL | RISK FACTORS | CHANGES | ADMINISTRATION AND DOSAGE | Biology | Endocrine System | Family Planning | Estrogens | Social Change | Drugs | Treatment Document Number: 052284 |
| 19. Title: Clinicians choose distinctive approaches to OC management. Source: CONTRACEPTIVE TECHNOLOGY UPDATE. 1987 Sep;8(9):118-20. Abstract: A survey of comparing management styles regarding oral contraceptives of 294 nurse practitioners, 152 physicians, 24 nurse midwives and 25 physician's assistants is reported. The 1st choice of pill was ON7/7/7 among 64% of nurse practitioners, 60% of physician's assistants, 57% of physicians, and 47% of nurse midwives. Triphasic pills were preferred by 70% of nurse practitioners, 70% of physicians, 62% of nurse midwives and 60% of physician's assistants. Next choices were ON 1/35 or Norinyl 135 (Syntex). In answer to the question whether to prescribe pills to daughters of mothers who took diethylstilbestrol, all physician's assistants and 95% of physicians would, but only 80 and 53% of nurse practitioners and nurse midwives would do so, preferring to refer the patient to a physician, who would prescribe pills. The results followed a similar trend in answer to the question of giving pills to a very young sexually active teen: 83% of physicians, 72% of physician's assistants, 65% of nurse practitioners and 64% of nurse midwives would give out pills. The most common age ceiling for oral contraceptive prescription was 40 years; physicians more often would make exceptions and prescribe to women over 50, while the other clinicians spread their answers broadly over ages 35, 40, 45 and 50. Language: English Keywords: NORTH AMERICA | UNITED STATES OF AMERICA | CONTRACEPTION | FAMILY PLANNING | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | ORAL CONTRACEPTIVES, PHASIC | DIETHYLSTILBESTROL | AGE FACTORS | HEALTH PERSONNEL | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | NURSES AND NURSING | PHYSICIANS | CONTRAINDICATIONS | Americas | Developed Countries | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives, Combined | Oral Contraceptives | Contraceptive Methods | Estrogens | Hormones | Endocrine System | Physiology | Biology | Population Characteristics | Demographic Factors | Population | Delivery of Health Care | Treatment Document Number: 044204 |
| 20. Title: Most clinicians feel DES exposure does not contraindicate OC use. Source: CONTRACEPTIVE TECHNOLOGY UPDATE. 1987 Oct;8(10):127-9. Abstract: Although concerns about a possible association between exposure to diethylstilbestrol (DES) in utero, use of combined oral contraceptives (OCs), and cervical/vaginal carcinoma have been largely allayed, many physicians remain cautious with DES daughters. Over 80% of the 621 physician respondents in a 1987 Contraceptive Technology Update survey indicated they would prescribe combined OCs for DES offspring, but half of them would require more frequent or more thorough follow-up than with their other OC patients. There are indications that areas of metaplasia in the vagina convert into a malignancy faster in DES-exposed women than in nonexposed patients. Of the 16% of physicians who said they would not prescribe OCs for a DES daughter, the majority indicated they would refer the patient to a specialist who would probably prescribe OCs. Only 1.5% said they considered DES exposure to be an absolute contraindication to OC use. Physicians generally indicated that they would move more quickly to perform a colposcopy on DES-exposed patients in the event of abnormal Pap findings. Others noted that more extensive follow-up on DES daughters may not be clinically essential but good policy from a medicolegal standpoint. Language: English Keywords: SURVEYS | PHYSICIANS | HEALTH PERSONNEL | DELIVERY OF HEALTH CARE | DIETHYLSTILBESTROL | HORMONES | REPRODUCTIVE CONTROL AGENTS | FAMILY PLANNING | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | CERVICAL CANCER | VAGINAL CANCER | CANCER | NEOPLASMS | DISEASES | SIDE EFFECTS | CONTRAINDICATIONS | Sampling Studies | Studies | Research Methodology | Health | Estrogens | Endocrine System | Physiology | Biology | Contraceptive Methods | Contraceptive Agents | Treatment Document Number: 044718 |
| 21. Title: [Post coital contraception] La contraception post-coitale. Author: Emperaire JC Source: REVUE DE MEDECINE. 1987 Jan 26;22(4):219-22. Abstract: Currently available methods of postcoital fertility control include either chemical or mechanical means usable after a single intercourse when ovulation has already occurred. Chemical postcoital contraception is achieved through administration of a high dose of estrogen. Several mechanisms of action have been proposed, all of which have in common the intervention of estrogenic effects between the time of fertilization in the tube and implantation in the uterus. Regulation of these phenomena is controlled by secretions of the corpus luteum, which in turn depend on pituitary secretion of luteinizing hormone (LH). Among proposed but as yet unproved mechanisms of action, the estrogen dose may interfere with tubal transport of the egg, exert a cytotoxic effect on the egg, retard endometrial maturation so that implantation is impossible, or provide a luteolytic effect. The only mechanism that has been demonstrated is alteration of luteal steroidogenesis. The action may be exercised directly on the corpus luteum, but more likely it is the result of inhibition by estrogen of pituitary LH secretion. The reversibility of the effect by the human chorionic gonadotropin produced by the placenta perhaps means that estrogens have no further contraceptive efficacy after implantation. Absolute efficacy of the method requires a daily dose of 5 mg of ethinyl estradiol (EE) administered over 5 consecutive days beginning if possible within 24 hours and at most 72 hours of the unprotected intercourse. The usual side effects of estrogens may be seen at these high doses, including nausea in over half of cases, vomiting in half, and headaches, vertigo, abdominal pain and other problems in 10%. About 10% of cases experience very heavy bleeding. 1/3 of women have no secondary effects. Cardiovascular diseases, hypertension, and disturbed hydromineral metabolism are the main contraindications. The failure rate is .03% if pregnancies occurring after inadequate doses, late administration, or repeated intercourse are excluded. No congenital malformations have been observed in cases of failure, but the rate of extrauterine pregnancies appears elevated; the method apparently inhibits intrauterine but not extrauterine implantation. The same effect appears to be attained with daily administration over 5 days of 30 mg of conjugated estrogens which produce fewer side effects. Injection of 50 mg of conjugated estrogen over 2 days and administration on the day following unprotected coitus of 2 tablets containing 50 mcg of ethinyl estradiol and 50 mg of Norgestrel are under study. The conditions of a single coitus in the periovulatory period must be met. Insertion of an IUD in the 5 days following unprotected intercourse assures effective inhibition of implantation without estrogen side effects. It provides continuing contraception but entails elevated risks of infection and is inappropriate for nulliparas. The usual contraindications to IUD use must be observed. Language: French Keywords: CONTRACEPTIVE AGENTS, POSTCOITAL | FERTILITY CONTROL, POSTCOITAL | IUD | CONTRACEPTION | FAMILY PLANNING | IMPLANTATION SUPPRESSION | FERTILIZATION | OVUM TRANSPORT | REPRODUCTION | ETHINYL ESTRADIOL | HORMONES | REPRODUCTIVE CONTROL AGENTS | EMERGENCY CONTRACEPTION | SIDE EFFECTS | ADMINISTRATION AND DOSAGE | LUTEINIZING HORMONE | DIETHYLSTILBESTROL | CONTRACEPTIVE AGENTS, SIDE EFFECTS | WOMEN | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Methods | Contraceptive Mode of Action | Contraceptive Agents, Estrogen | Endocrine System | Physiology | Biology | Treatment | Drugs | Gonadotropins, Pituitary | Gonadotropins | Estrogens | Demographic Factors | Population Document Number: 042146 |
| 22. Title: The etiology of ectopic pregnancy. Author: Russell JB Source: CLINICAL OBSTETRICS AND GYNECOLOGY. 1987 Mar;30(1):181-90. Abstract: The causes of ectopic pregnancy, divided into those arising from abnormal ovum transport and those due to abnormalities of the egg itself, are presented. The fallopian tube is not a passive conduit, but the active site of sperm capacitation, egg capture and fertilization. Conditions resulting in damage to tubal lining such as salpingitis, even if it is subclinical as often occurs with Chlamydia, increase risk of tubal pregnancy. Other causes of damage to tubes include vaginal douching, especially with commercial products, laparoscopic tubal ligation if it creates fistulas, even microsurgical reconstruction and conservative surgery for prior ectopic pregnancy. For unknown reasons, IUD use, the thickening of the tube seen in salpingitis isthmic nodosa, and exposure to diethylstilbestrol are also risk factors. Unresolved is the controversy over whether previous induced abortions predispose one ectopic pregnancy; possibly 2 or more abortions, or illegal abortions may adversely affect the statistics. Factors detrimental to ovum quality that lead to ectopic pregnancy include induced ovulation, in vitro fertilization, delayed ovulation and migration of the ovum to the contralateral tube. Language: English Keywords: PREGNANCY | PREGNANCY, ECTOPIC | PREGNANCY COMPLICATIONS | PREGNANCY, TUBAL | PELVIC INFECTIONS | FERTILITY MEASUREMENTS | HIGH RISK WOMEN | IUD | INFECTIONS | FALLOPIAN TUBES | BACTERIAL AND FUNGAL DISEASES | SEXUALLY TRANSMITTED DISEASES | CHLAMYDIA | LAPAROSCOPY | ENDOSCOPY | TUBAL EFFECTS | TUBAL MOTILITY EFFECTS | ADNEXAL EFFECTS | TUBAL OCCLUSION | TUBAL LIGATION | TUBAL REANASTOMOSIS | STERILIZATION REVERSAL | SURGERY | FEMALE STERILIZATION | DIETHYLSTILBESTROL | HORMONES | ABORTION | OVUM | GERM CELLS | OVULATION | OVUM TRANSPORT | GENITALIA, FEMALE | Reproduction | Diseases | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Genitalia | Urogenital System | Physiology | Biology | Reproductive Tract Infections | Physical Examinations and Diagnoses | Examinations and Diagnoses | Genital Effects, Female | Sterilization, Sexual | Reversible Sterilization | Treatment | Estrogens | Endocrine System | Fertility Control, Postconception Document Number: 043734 Notification |
| 23. Title: A clinician's experience with postcoital contraception at a university health service. Author: Schilling LH Source: [Unpublished] 1987. Presented at the Fifth Annual Meeting of the Society for the Advancement of Contraception, Caracas. Venezuela, October 5-8, 1987. [1], 5 p. Abstract: Over a span of 11 years, a variety of postcoital contraceptive regimens have been offered. High doses of diethylstilbestrol for 5 days was the original method. For a period of time, students were given a choice between different regimens and chose a high-dose estrogen 9% of the time, copper IUDs 2% and ethinyl estradiol/dl-norgestrel combined 89% of the time. Among the 1071 patients who used postcoital contraception (PCC) with satisfactory followup, there were 18% pregnancies (1.68%). Side effects were minimal and limited to nausea and vomiting. 2/3 of the patients reported no problems. On the basis of this experience and on published reports, ethinyl estradiol/dl-norgestrel combined appears to be as effective as any other available PCC agent. It is also a simpler combination. This, along with 1 10 mg capsule of prochlorperazine, is the only regimen currently being offered at the University. A survey of 437 students coming to this clinic in 1984 revealed that 41% had had a therapeutic abortion. 85% of the females who had abortion were unaware of PCC at the time of their unintended conception. To help increase awareness of PCC, the clinic now routinely counsels all patients about it when contraception is discussed. Providing PCC also affords an opportunity to discuss traditional contraception with a high-risk group of females to attempt to decrease the incidence of future unintended pregnancies. (author's modified) Language: English Keywords: UNITED STATES OF AMERICA | CALIFORNIA | HEALTH SERVICES | UNIVERSITIES | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTIVE AGENTS, POSTCOITAL | ABORTION | IUD, COPPER RELEASING | CONJUGATED ESTROGENIC SUBSTANCES | DIETHYLSTILBESTROL | ORAL CONTRACEPTIVES, COMBINED | ETHINYL ESTRADIOL | NORGESTREL | KNOWLEDGE | PREGNANCY, UNPLANNED | TREATMENT | EMERGENCY CONTRACEPTION | SIDE EFFECTS | ADMINISTRATION AND DOSAGE | CONTRACEPTIVE AGENTS, SIDE EFFECTS | WOMEN | North America | Americas | Developed Countries | Delivery of Health Care | Health | Schools | Education | Contraceptive Usage | Contraception | Family Planning | Contraceptive Agents, Female | Contraceptive Agents | Fertility Control, Postconception | IUD | Contraceptive Methods | Estrogens | Hormones | Endocrine System | Physiology | Biology | Oral Contraceptives | Contraceptive Agents, Estrogen | Contraceptive Agents, Progestin | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Drugs Document Number: 050720 Notification |
| 24. Title: [Interactions of androgens and estrogens in the control of reproduction] Interactions des androgenes et des oestrogenes dans le controle de la reproduction. Author: Schumacher M; Alexandre C; Balthazart J Source: COMPTES RENDUS DE L ACADEMIE DES SCIENCES. SERIE III, SCIENCES DE LA VIE. 1987 Nov 7;305(14):569-74. Abstract: In the 1st report of regulation by the brain of sexual behavior by both estrogen and androgen simultaneously, brain aromatase, LH and FSH secretion and sexual behavior were monitored in castrated quail. 32 castrated male quail (Coturnix coturnix japonica) were injected daily with i) testosterone 1 mg (7 birds); ii) the synthetic androgen methyltrienolone, R 1881 (Roussel-Uclaf) 1 mg (7), iii) diethylstilbestrol (DES) 200 mcg (7); iv) R 1881 1 mg and DES 200 mcg (6); v) or solvent controls (5). Injections were in propylene glycol for 25 days. Behavioral tests for male sexual behavior, receptivity and crowing were performed, LH and FSH were radioimmunoassayed, and aromatase was assayed in preoptic tissue. Both R 1881 and DES activated male sexual behavior, inhibited LH and FSH secretion and increased hypothalamic aromatase activity. The effects on aromatase and FSH of R1881 and DES were additive. Thus both androgen and estrogen receptors may be involved in control of both gonadotropin release and sexual behavior in this species. Language: French Keywords: FRANCE | LABORATORY ANIMALS | SEX BEHAVIOR | HORMONES | ANABOLIC STEROIDS | DIETHYLSTILBESTROL | TESTOSTERONE | FOLLICLE STIMULATING HORMONE | LUTEINIZING HORMONE | ENZYMES | Europe, Western | Europe | Developed Countries | Clinical Research | Research Methodology | Behavior | Endocrine System | Physiology | Biology | Androgens | Estrogens | Gonadotropins, Pituitary | Gonadotropins | Enzymes and Enzyme Inhibitors Document Number: 058627 |
| 25. Title: [Postcoital contraception] La contraception post-coitale. Author: Serfaty D Source: GYNECOLOGIE. 1987;38(3):201-5. Abstract: Postcoital contraceptive methods could potentially decrease resort to abortion if women were aware of their existence. Classic postcoital contraception can be achieved with estrogens, progestins, combinations of the two, and by IUDs. 50 mg/day of diethylstilbestrol or 5 mg/day of ethinyl estradiol for 5 days beginning within 72 hours of unprotected intercourse have failure rates of 0-2% in producing abortion. The mechanism is not well understood but probably includes luteolysis and action on the development of the endometrium. Nausea, vomiting, breast pain, and metrorrhagia are very common side effects. The rate of extrauterine pregnancies in cases of method failure is high, and there is a theoretical risk of cancer in daughters whose mothers have taken DES. .6 mg of norgestrel in the 12 hours following unprotected coitus gave a failure rate of 3.6% among 112 women. Spotting and a shortening of the cycle were the main side effects noted, with nausea and breast pain less frequent. The advantage of a very small steroid dose is offset by the disadvantage of requiring application in the 1st 12 hours. Several combinations of estrogens and progestins have been prepared, of which the most interesting is 1 mg of dl-norgestrel and 100 mcg of ethinyl estradiol repeated exactly 12 hours later. Treatment must begin in the 72 hours following a single unprotected coitus. A failure rate of 1.6% was obtained in a multicenter study of 692 women. This method has become the most common postcoital method because of its efficacy, simplicity, and acceptability. The most common secondary effects are nausea and vomiting, which affect 52.7% of users. Compared to estrogens alone, the ethinyl estradiol-norgestrel combination takes 12 hours instead of 5 days to administer, requires 4 pills instead of 50 or 60, is better tolerated, and requires a much lower dose of estrogen. Efficacy of the 2 methods is comparable or slightly superior with estrogens alone at high doses. Copper IUDs inserted on any cycle day between ovulation and implantation are 100% effective, can be used beyond the 72 hours of efficacy for hormonal methods, and are the only postcoital method currently available for women with contraindications to hormonal methods. The IUD can be left in place to provide longterm protection. The main disadvantage is the possibility of infection, especially in young nulliparas. A history of previous extrauterine pregnancy contraindicates use of the IUD and of hormonal postcoital methods. Postcoital use of RU-486 has given promising results in trials, and luteinizing hormone releasing hormone agents are under study. Postcoital contraception will never substitute for conventional methods, but should be available for use in emergency situations as appropriate. Postcoital use of RU-486 has of the IUD and of hormonal postcoital methods. Postcoital use of RU-486 has given promising results in trials, and luteinizing hormone releasing hormone agents are under study. Postcoital contraception will never substitute for conventional methods, but should be available for use in emergency situations as appropriate. Language: French Keywords: CONTRACEPTIVE AGENTS, POSTCOITAL | FERTILITY CONTROL, POSTCOITAL | EVALUATION | DIETHYLSTILBESTROL | ETHINYL ESTRADIOL | NORGESTREL | IUD | COPPER | TIME FACTORS | RU-486 | CONTRACEPTION RESEARCH | FEMALE CONTRACEPTION | EMERGENCY CONTRACEPTION | ADMINISTRATION AND DOSAGE | INORGANIC CHEMICALS | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Estrogen | Contraceptive Agents, Progestin | Contraceptive Methods | Metals | Vitamins and Minerals | Population Dynamics | Demographic Factors | Population | Hormone Antagonists | Drugs | Treatment | Ingredients and Chemicals Document Number: 060414 |
| 26. Title: Hormonal steroid contraception: a critical review of recent advances. Author: Sinnathuray TA Source: In: Recent advances in contraceptive technology. Proceedings of the Seminar held on 14-20 October 1987 in Chiang Mai, Thailand, organised by International Planned Parenthood Federation [IPPF]. East and South East Asia and Oceania Region [ESEAOR]. Kuala Lumpur, Malaysia, IPPF, ESEAOR, [1987]. :107-14. Abstract: Oral contraceptives were developed in the 1950s and became available in the US in 1960. Over the years, the estrogen content of pills has been reduced from 100 mcg to as low as 30 mcg, and the progestagen content has been reduced from 10 mg to as low as 125 mcg. The latter reduction has been made possible by the discovery of more effective progestagens, such as norgestrel. Very low dose progestagen-only oral contraceptives, called minipills, have a higher frequency of failure but are recommended for women who are obese or have diabetic, hypertensive or thromboembolitic predisposition. Once-a-month pills containing a long acting estrogen, quinestrol, or quinestrol combined with a longacting progestagen, quingestonon, are absorbed from the gastrointestinal tract and stored in depot fat for slow release. They are not yet reliable enough for routine use. Morning-after pills, containing high doses of stilbestrol, estrogen, or ethinylestradiol, taken twice daily for 5 days, are associated with severe side effects, such as nausea, vomiting, and bleeding. Diethylstilbestrol has been associated with cervical and vaginal neoplasms in the daughters of women who took it during pregnancy. Oral contraceptives work by acting on the hypothalamo-hypophyseal axis and directly on the ovary, cervical mucus, endometrium, and fallopian tubes. Common side effects of estrogens are nausea, headache, menstrual irregularities, and hypertension. Common side effects of progestagens are leucorrhea, menstrual disorders, weight gain, breast fullness, and premenstrual depression. There is no conclusive evidence that oral contraceptives cause cancer of the breast, endometrium, or cervix. They have, however, been a associated with thromboembolic disease and hypertension and may be involved in liver and gallbladder dysfunction and possibly with spontaneous abortion and fetal anomalies. Contraindications to the use of steroid hormone contraceptives are pregnancy, breast cancer, venous thromboses and varicosities, jaundice, diabetes, hypertension, congestive heart disease, epilepsy, asthma, and eczema. Oral contraceptive acceptors should be given an initial complete physical examination and should be monitored regularly. Language: English Keywords: LITERATURE REVIEW | ORAL CONTRACEPTIVES, SIDE EFFECTS | ORAL CONTRACEPTIVES, COMBINED | LOW-DOSE PROGESTINS | CONTRACEPTIVE AGENTS, POSTCOITAL | NORGESTREL | QUINESTROL | DIETHYLSTILBESTROL | THROMBOEMBOLISM | GALLBLADDER DISEASES | HYPERTENSION | LIVER DYSFUNCTION | CARBOHYDRATE METABOLIC EFFECTS | LIPID METABOLIC EFFECTS | NEONATAL DISEASES AND ABNORMALITIES | BREAST CANCER | CERVICAL CANCER | ENDOMETRIAL CANCER | VAGINAL CANCER | MENSTRUATION DISORDERS | OVARIAN EFFECTS | ENDOMETRIAL EFFECTS | NAUSEA | EMERGENCY CONTRACEPTION | SIDE EFFECTS | ADMINISTRATION AND DOSAGE | Contraceptive Safety | Safety | Public Health | Health | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Estrogens | Hormones | Endocrine System | Physiology | Biology | Embolism | Vascular Diseases | Diseases | Metabolic Effects | Lipids | Cancer | Neoplasms | Ovary | Genitalia, Female | Genitalia | Urogenital System | Endometrium | Uterus | Signs and Symptoms | Treatment | Drugs Document Number: 057457 |
| 27. Title: Risk factors associated with the use of sex hormones. Author: Taylor W Source: ANTICANCER RESEARCH. 1987 Sep-Oct;7(5B):943-8. Abstract: The risk of contracting neoplastic liver disease after taking synthetic sex hormones, either estrogens or androgens, is discussed. Since the 1st reports that oral contraceptives were associated with liver neoplasms in the 1970s, tests on laboratory animals have suggested that sex steroids act as promoters of hepatocarcinogenesis in suitably initiated animals, and that some hormones act as weak complete carcinogens in certain lab hosts. It is known that oral contraceptives induce benign hepatic adenoma: hundreds of cases have been reported. These adenomas regress when women stop taking orals. The possible progression to malignant lesions is difficult to assess. Although a 1982 case review of women with hepatocellular carcinoma concluded that the association was a coincidence, 2 more recent epidemiological studies have proposed that there is a possible link between pills and hepatocarcinoma as well as cholangiosarcoma. In favor of the association is the finding that the histopathology of carcinoma in pill users differs from that in nonusers. Arguing against a causative role is the fact that natural cyclic estrogen levels are much higher than those found in pill users. Overall, the risk of developing liver cancer is far lower than the risk of other serious consequences of pill use, for example thromboembolism, and must be judged in the context of the many protective effects of the pill. The estrogen DES or diethylstilbestrol is no longer being used, but cases of clear-cell adenocarcinoma are still appearing in the daughters of its users. Anabolic androgens, prescribed therapeutically or abused, are known to cause liver neoplasms, primarily hepatocellular carcinoma, but also adenomas, focal nodular hyperplasia, cholangiosarcoma and angiosarcoma. The legitimate use of these steroids is on a much smaller scale, and for short periods of time, compared to oral contraceptives, so the causative role of androgens in neoplasia is less well known. With any of these drugs, especially in areas where potential cancer initiators such as oncogenes or viruses are endemic, careful screening is vital for safe use. Language: English Keywords: FAMILY PLANNING | CONTRACEPTION | CONTRACEPTIVE AGENTS, FEMALE | ORAL CONTRACEPTIVES | HORMONES | ANABOLIC STEROIDS | DIETHYLSTILBESTROL | ANDROGENS | ESTROGENS | DISEASES | HEPATIC EFFECTS | LIVER NEOPLASMS | NEOPLASMS | CANCER | RISK FACTORS | MORTALITY | Contraceptive Agents | Contraceptive Methods | Endocrine System | Physiology | Biology | Population Dynamics | Demographic Factors | Population Document Number: 052304 |
| 28. Title: Postcoital contraception: a cover-up story. Author: Van Look PF Source: In: Fertility regulation today and tomorrow, [edited by] E. Diczfalusy and M. Bygdeman. New York, New York, Raven Press, 1987. :29-42. (Serono Symposia Publications from Raven Press, Volume 36) Abstract: Since 1983, there have been few advances made in the search for a postcoital agent suitable for repeated use. The criteria to be fulfilled by such an agent are formidable. The ideal postcoital drug should have the ability to interfere with pre-embryonic development or with implantation, a fairly long duration of action, the capacity to provide full interceptive protection even when taken only once, and a high selectivity of action so that menstrual cyclicity is not disturbed. Such a drug should be safe, cheap, and active in an oral or other easily self-administrable form. Current postcoital methods for emergency use involve either administration of steroid hormones (estrogens or estrogen/progestogen combinations), or insertion of a copper-releasing IUD. No major side effects have been reported following postcoital steroid treatment, except for 1 case of acute pulmonary edema. Side effects include nausea, vomiting, headache, dizziness, breast tenderness, and disturbances of the menstrual cycle. Advantages of the IUD as a postcoital method are its high efficacy and the fact that it can be used up to 5 days after coital exposure (48 hours beyond hormonal methods). Side effects include pain and bleeding, and the risk of pelvic inflammatory disease. Also, if this method failed and the IUD were to remain in place, or if an IUD were inserted into the gravid uterus of a pregnant woman, the woman would be subject to an increased risk of spontaneous abortion and of septic mid-trimester abortion. Language: English Keywords: DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | NEEDS | IUD SIDE EFFECTS | DIETHYLSTILBESTROL | CONTRACEPTIVE AGENTS, POSTCOITAL | POSTCOITAL DOUCHING | FERTILITY CONTROL, POSTCOITAL | ETHINYL ESTRADIOL | LEVONORGESTREL | NORETHINDRONE | QUINGESTANOL ACETATE | EMERGENCY CONTRACEPTION | SIDE EFFECTS | Economic Factors | IUD | Contraceptive Methods | Contraception | Family Planning | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Agents, Estrogen | Contraceptive Agents, Progestin | Treatment Document Number: 201601 |
| 29. Title: Post coital interception with steroids. Author: van Santen MR; Haspels AA Source: WIENER MEDIZINISCHE WOCHENSCHRIFT. 1987;137(18-19):465-70. Abstract: The historical development, current use, indications, side effects and complications of postcoital interception (PCI), and recent evolution of other forms of anti-implantation medications are reviewed by the originator of Holland's postcoital program, the "Haspel" method. PCI was first used in the 1960s in the US, with diethylstilbestrol. Haspel administered estrogen in the Netherlands in 1964, and combined estrogen-progestins were introduced in Ontario, the "Yuzpe" method in 1974. Now Holland uses postcoital combined pills routinely as an emergency method mainly for adolescents impregnated on their 1st unprotected intercourse (25% of patients). Patients are immediately prescribed effective contraception. As a result, Holland has the lowest teen pregnancy rate in the developed world, 14 per 1000, compared to 45 in the UK and 96 per 1000 in the US. In Holland 25,000 PCI treatments were given in 1982, compared to 15,000 abortions. In contrast, Sweden performed 25,000 abortions and few PCIs. Current practice is to give 2 low dose ethinyl estradiol-norgestrel oral contraceptive within 12 hours of unprotected intercourse, followed by 2 more 12 hours later. Newer methods being used include 400 mcg d-norgestrel within 3 hours after coitus, with failure rates of 1.7-4.2 pregnancies per 100 woman-years in Austria, Germany and Holland. Mifepristone has also been tried as a menstrual inducer, given on Days 27-30. The only serious complication of PCI is ectopic pregnancy, in about 10% of failures. No teratogenic effects or other complications have been reported. Side effects are nausea and vomiting, tender breasts and menorrhagia in 25-50%, even if the combined pills are used. The midcycle PCI method may be ethically acceptable to those who do not consider abortion to have occurred before implantation. Treatment in luteal phase, e.g. with mifepristone, is effective during implantation. Language: English Keywords: NETHERLANDS | LITERATURE REVIEW | CONTRACEPTION FAILURE | FERTILITY CONTROL, POSTCOITAL | CONTRACEPTIVE AGENTS, POSTCOITAL | RU-486 | ETHINYL ESTRADIOL | DIETHYLSTILBESTROL | NORGESTREL | CONTRACEPTIVE AGENTS, PROGESTIN | ADOLESCENT PREGNANCY | PREGNANCY, UNPLANNED | SERVICE STATISTICS | PREGNANCY, ECTOPIC | CHILD HEALTH SERVICES | |