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Peer Reviewed

Title: Multiple bladder calculi: a rare cause of irreducible uterine prolapse.
Author: Dahiya P; Gupta A; Sangwan K
Source: Archives of Gynecology and Obstetrics. 2007 May;275(5):411-412.
Abstract: A vesical calculus in a prolapsed cystocele is rare. The objective was to highlight bladder calculi as a cause of irreducible uterine prolapse. A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CASE STUDIES | WOMEN | GALLBLADDER DISEASES | SURGERY | UTERINE EFFECTS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Demographic Factors | Population | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 315239

Peer Reviewed

Title: A high cholecystectomy rate in a cohort of Mexican American women who are postpartum at the time of oral contraceptive pill initiation.
Author: Stuart GS; Tang JH; Heartwell SF; Westhoff CL
Source: Contraception. 2007 Nov;76(5):357-359.
Abstract: Opinions regarding the association between gallbladder disease and oral contraceptive (OCs) differ. The objective of this article is to quantify cholecystectomy rate among women initiating OCs. Women under the age of 25 years were enrolled at four sites in a randomized trial evaluating initiation of OCs. Hospitalizations while enrolled were elicited during follow-up interviews, and medical records of women who underwent cholecystectomy were reviewed. Of 757 women enrolled at University of Texas Southwestern Medical Center (UTSW), 8 underwent cholecystectomy, a rate of 25.3/1000 woman-years (95% CI=8.1, 42.5). All eight were Mexican American and postpartum when they initiated OCs. The expected rate is 4.2/1000 woman-years for U.S. women aged 15-44. Women enrolled at the UTSW site had an increased rate of cholecystectomy and were more likely to be postpartum and Mexican American than women enrolled at the other sites. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | FOLLOW-UP STUDIES | POSTPARTUM WOMEN | HISPANICS | FAMILY PLANNING ACCEPTORS | ORAL CONTRACEPTIVES, SIDE EFFECTS | GALLBLADDER DISEASES | SURGERY | TIME FACTORS | Developed Countries | North America | Americas | Studies | Research Methodology | Puerperium | Reproduction | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Family Planning Programs | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Population Dynamics
Document Number: 321770

4.
Title: Management of symptomatic cholelithiasis in pregnancy.
Author: Chiedozi LC; Al Hadi FN; Salem MM; Al Moaidi FA; Okpere EE
Source: Annals of Saudi Medicine. 2001;21(1-2):38-41.
Abstract: Symptomatic cholelithiasis occurs in pregnancy in our patient population, some of whom are diabetic. But its management remains controversial. How common is the problem? Is our current policy of management appropriate for our patients? The management of 162 pregnant patients admitted over a ten-year period with symptomatic cholelithiasis was evaluated in a retrospective study. The patients were divided into two groups: Group A, 58 patients with diabetes mellitus, and Group B, 104 nondiabetic patients. Symptomatic cholelithiasis occurred in only 0.3% of our pregnant patients. Of 162 patients, 148 (91.4%) had successful conservative (nonsurgical) management. There was no fetal loss, premature birth, maternal morbidity or mortality. Fourteen patients who had failure of conservative treatment had surgical management. When the postpartum cholecystectomy hospitalization days were added to the total days of admission for the nonoperative cases, there was a significant difference in the mean total number of days of hospitalizations between the surgical cases, 12.4 days, and the nonsurgical cases, 20.5 days (P < 0.001), but not in the mean number of hospitalizations, 2.3 versus 3.3. Our current policy of conservative management seems optimal. It has, however, been achieved at the price per patient of 8 extra days of hospitalization. In keeping with recent improvements in surgery and the advent of laparoscopic surgery, a more cost-efficient approach would suggest a more aggressive policy. (author's)
Language: English
Keywords:
SAUDI ARABIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | PREGNANT WOMEN | GALLBLADDER DISEASES | TREATMENT | SURGERY | DIABETES | Middle East | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 304534

5.
Title: A prospective review of laparoscopic cholecystectomy in Brunei.
Author: Kok KY; Mathew VV; Tan KK; Yapp SK
Source: SURGICAL LAPAROSCOPY & ENDOSCOPY. 1998 Apr;8(2):120-2.
Abstract: Laparoscopic cholecystectomy for the treatment of gallstone disease has the advantages of a shorter postoperative stay, more rapid overall recovery time, and better cosmesis compared to open cholecystectomy. To assess the state of development of laparoscopic cholecystectomy in Brunei, a prospective review of all 220 such procedures performed at the RIPAS Hospital in Bandar Seri Begawan in 1992-96 was conducted. These cases represent the total number of procedures performed in Brunei to date. The standard four-portal technique was used with an open Hasson trocar placed at the umbilicus. 81 patients (37%) were male and 139 (63%) were female; the mean age of patients was 46 years. Indications for the procedure included biliary colic (130 cases), acute cholecystitis (47 cases), and obstructive jaundice caused by gallstones (26). The mean operating time was 109 minutes. 9 patients (4%) required conversion to open surgery. The overall morbidity rate was 5%, with one ductal injury (0.5%). Gallbladder perforation with leakage of bile and/or gallstones occurred in 17% of cases. There was 1 death in this series (0.5% mortality), involving an 87-year-old woman with postoperative bronchopneumonia. 57% of patients did not require any form of analgesia in the postoperative period. The mean hospital stay was 3 days.
Language: English
Keywords:
BRUNEI | RESEARCH REPORT | PROSPECTIVE STUDIES | GALLBLADDER DISEASES | CHOLESTASIS | SURGERY | Asia, Southeastern | Asia | Developed Countries | Studies | Research Methodology | Diseases | Hepatic Effects | Physiology | Biology | Treatment
Document Number: 138452

6.
Title: Benign gallbladder disease: newer data suggest little or no excess risk with oral contraceptive use.
Source: CONTRACEPTION REPORT. 1997 Nov;8(5):9-11.
Abstract: Studies conducted during the 1970s suggested that oral contraceptives (OCs) were associated with an increased risk of gallbladder inflammation and gallstone formation and this risk is outlined in OC product labeling. However, more recent analyses have found either no increased risk of gallbladder disease or, at most, a small, transitory increased risk with current OC use. Moreover, a meta-analysis of 27 controlled epidemiologic studies of this association found that only nine studies used rigorous methodological standards. Although these nine studies detected a 30-40% increased risk of gallbladder disease in OC users, all of the 95% confidence intervals included 1.0 and are thus not statistically significant. After 1982, no studies recorded risks of 1.5 or greater. Finally, data from two large cohort studies--the UK Royal College of General Practitioners OC Study and the Oxford Family Planning Association Study--indicate the risk estimate has decreased further with subsequent analyses. The findings of many studies of the association between OCs and gallbladder disease are compromised by a failure to independently assess the effects of decreasing OC hormone doses over time, duration of OC use, transiency of the effect, and increasing prevalence of gallstones by age and to control for confounding factors such as smoking and parity.
Language: English
Keywords:
LITERATURE REVIEW | ORAL CONTRACEPTIVES, SIDE EFFECTS | GALLBLADDER DISEASES | RISK FACTORS | BIAS | CONTRACEPTIVE METHODS | SIDE EFFECTS | Contraceptive Safety | Safety | Public Health | Health | Diseases | Biology | Error Sources | Measurement | Research Methodology | Contraception | Family Planning | Treatment
Document Number: 130010

7.
Title: Acute pancreatitis in pregnancy.
Author: Chen CP; Wang KG; Su TH; Yang YC
Source: Acta Obstetrica et Gynecologica Scandinavica. 1995 Sep;74(8):607-10.
Abstract: During August 1989-August 1994 at the referral-based obstetric practice of MacKay Memorial Hospital in Taipei, Taiwan, obstetricians saw 8 pregnant women with acute pancreatitis. All but 1 patient had gallstones and/or hyperlipidemia. None had ever been diagnosed with pancreatitis or gallstones in the past. None suffered from alcoholism. One woman was lost to follow-up at 33 weeks gestation. No pregnant woman died. Magnesium sulfate and nifedipine controlled preterm labor in 2 patients. Two women underwent cesarean section (fetal distress and elective). Pancreatitis struck all but 1 during the 3rd trimester of pregnancy. One woman presented at 23 weeks gestation with loss of consciousness, abnormally low volume of circulating plasma in the body, upper gastrointestinal bleeding, and a dead fetus. She also had diabetes mellitus which had gone untreated for 2 years. After spontaneous delivery of the dead fetus, she developed metabolic encephalopathy, sepsis, respiratory distress, and acute renal failure. She completely recovered and left the hospital 62 days after arriving. Physicians instituted conservative treatment for pancreatitis and a fat-restricted diet for hyperlipidemia. Labor was induced in 3 women after determining fetal lung maturity. Pancreatitis symptoms diminished after delivery. At 2 weeks postpartum, they underwent cholecystectomy. In fact, all but 3 women underwent cholecystectomy. Five patients had a fever greater than 38 degrees Celsius upon admission. Three patients were jaundiced. All 8 patients experienced nausea and/or vomiting and abdominal pain. Six women had low serum calcium levels. Only 1 had a serum lactic dehydrogenase level above 350 IU/L. Primiparous women were just as likely to develop pancreatitis during pregnancy as multiparous women. These findings suggest that early diagnosis and prompt treatment of acute pancreatitis are essential to a favorable outcome.
Language: English
Keywords:
TAIWAN | RETROSPECTIVE STUDIES | PREGNANCY, THIRD TRIMESTER | PREGNANCY COMPLICATIONS | INFECTIONS | SIGNS AND SYMPTOMS | LIPIDS | GALLBLADDER DISEASES | TREATMENT | Asia, Eastern | Asia | Developed Countries | Studies | Research Methodology | Pregnancy | Reproduction | Diseases | Physiology | Biology
Document Number: 109337

8.
Title: Cigarette smoking and parity as risk factors for the development of symptomatic gall bladder disease in women: results of the Royal College of General Practitioners' oral contraception study.
Author: Murray FE; Logan RF; Hannaford PC; Kay CR
Source: GUT. 1994 Jan;35(1):107-11.
Abstract: The effects of cigarette smoking and parity on the development of symptomatic gallbladder disease remain controversial. These relations have been examined in a cohort of 46,000 women followed for up to 19 years during the Royal College of General Practitioners' oral contraception (OC) study. During follow-up, 1087 women were recorded as experiencing their first ever episode of symptomatic cholelithiasis (International Classification of Disease, 8th revision (ICD-8) 574) or cholecystitis (ICD-8 575). Smokers were more likely to develop symptomatic gallbladder disease than non-smokers (relative risk 1.19; 95% confidence intervals (95% CI) 1.06 to 1.34) and there was a significant trend with the number of cigarettes smoked daily (test for trend chi square = 7.58, p 0.01). This relation was most apparent among never users of OCs, although similar trends were found among current and former users. A significant direct relation between symptomatic gallbladder disease and parity was also found (test for trend chi square = 21.89, p < 0.001). When all were examined together, a trend of increasing risk with lower social class was also found (test for trend chi square = 5.72, p 0.02). Current OC users had a moderately increased risk of symptomatic gallbladder disease (relative risk 1.15; 95% CI 0.99 to 1.34), unlike former users (relative risk 1.03; 95% CU 0.90 to 1.18). These results suggest that smoking and parity are important risk factors for the development of symptomatic gallbladder disease in women. (author's)
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | TOBACCO USE | PARITY | GALLBLADDER DISEASES | COHORT ANALYSIS | ORAL CONTRACEPTIVES | Developed Countries | Europe, Western | Europe | Behavior | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Diseases | Research Methodology | Contraceptive Methods | Contraception | Family Planning
Document Number: 094529

9.
Title: Oral contraceptive use and benign gallbladder disease, revisited.
Author: Vessey M; Painter R
Source: CONTRACEPTION. 1994 Aug;50(2):167-73.
Abstract: Epidemiologists reexamined the association between oral contraceptive (OC) use and benign gallbladder disease, because their 1982 study had found a possible association in 227 women recruited from family planning clinics in England and Scotland between 1968 and 1974, and 255 more women in the cohort have since developed benign gallbladder diseases. They conducted a cohort analysis of the 482 women with benign gallbladder disease. No significant overall association between OC use and gallbladder disease existed (relative risk [RR] = 1.1). Neither total duration of OC use nor interval since last use of OCs were associated with gallbladder disease incidence (RR = 1 and 1.1 at > 97 months, respectively). The researchers did not find any interaction between OC use and body mass index or OC use and age in development of gallbladder disease. Based on these results, they concluded that OCs do not influence the development of gallbladder disease.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | COHORT ANALYSIS | ORAL CONTRACEPTIVES | GALLBLADDER DISEASES | Developed Countries | Europe, Western | Europe | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Diseases
Document Number: 097908

10.
Title: Pill use and gallbladder disease.
Author: Klitsch M
Source: Family Planning Perspectives. 1993 Nov-Dec;25(6):242.
Abstract: Oral contraceptive (OC) users may be at increased risk of gallbladder disease, according to a recent meta-analysis. Investigators found that results from 25 studies of gallbladder disease and the pill that were published between 1973 and 1991 were highly inconsistent. Only 9 of these studies handled all potential biases adequately, according to the researchers, and therefore could be classified as statistically reliable. 8 of these studies produced a relative risk of 1.1 or more; in 4 of them, the increase in risk was statistically significant. For 6 studies, in which all participants were screened for gallbladder disease, the pooled odds ratio was 1.36, and was statistically significant. Several of the studies suggested that any effect of pill use was transient and limited to the first few years of use. (full text)
Language: English
Keywords:
CRITIQUE | ORAL CONTRACEPTIVES | RISK FACTORS | GALLBLADDER DISEASES | DATA ANALYSIS | RELIABILITY | Contraceptive Methods | Contraception | Family Planning | Biology | Diseases | Research Methodology | Measurement
Document Number: 092106

11.
Title: Influence of oral contraceptives on fasting gallbladder volume.
Author: Pansini F; Campobasso C; Giorgetti L; Locorotondo GC; Agnello G; Bassi P; Costantino D; Sighinolfi D; Alvisi V; Mollica G
Source: GYNECOLOGICAL ENDOCRINOLOGY. 1993 Dec;7(4):267-71.
Abstract: In Italy, researchers used real-time ultrasonography for fasting (no solid food for 24 hours) gallbladder volume to compare data on 518 women using low-dose, combined oral contraceptives (OCs) for 12-120 months with data on 97 women who had never used OCs to examine the effect of OCs on the gallbladder. The 615 healthy, fertile 16-52 year old women were clients of Contraceptive Counseling Services of the Department of Obstetrics and Gynaecology at the University of Ferrara and the Local Sanitary Unit. No significant difference in fasting gallbladder volumes existed between cases and controls. OC use was not associated with fasting gallbladder volume in relation to duration of treatment, family cholelithiasis, smoking, or age. As parity increased so did fasting gallbladder volume in both groups (p = 0.04 for controls and p = 0.01 for cases). Fasting gallbladder volume increased with age in both groups but not significantly so. Biliary dysmorphism existed in 17.8% of OC users and 24.7% of controls. Cholelithiasis was present in 2.9% of OC users and 3.1% of controls. OC use did not affect the relative risk of biliary dysmorphism and cholelithiasis (0.66 and 0.95, respectively). In conclusion, low-dose OCs do not affect gallbladder motility.
Language: English
Keywords:
ITALY | RESEARCH REPORT | CASE CONTROL STUDIES | ORAL CONTRACEPTIVES, COMBINED | GALLBLADDER DISEASES | RISK FACTORS | Europe, Southern | Europe | Developed Countries | Studies | Research Methodology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Diseases | Biology
Document Number: 097992

12.
Title: Oral contraceptives and the risk of gallbladder disease: a meta-analysis.
Author: Thijs C; Knipschild P
Source: AMERICAN JOURNAL OF PUBLIC HEALTH. 1993 Aug;83(8):1113-20.
Abstract: Epidemiologists at Rijksuniversiteit Limburg in the Netherlands reviewed 25 controlled epidemiologic studies (27 publications) to examine the risk of gallbladder disease due to oral contraceptive (OC) use. 2 of the 4 follow-up studies were follow-up studies to the Royal College of General Practitioners OC Study and the Oxford/Family Planning Association Contraceptives Study, both of which were also included in this literature review. 9 case control studies examined OC use and incidence of gallstones. 9 other studies included healthy women screened for gallstones by ultrasound or x-ray. The last 4 studies examined prevalent cases of gallbladder disease and current and past OC use. Studies before 1982 had rate ratios or odds ratios of at least 2 (5 of 14 studies, 4 were statistically significant). After 1982, no study had a rate ratio or odds ratio greater than 1.4. The follow-up studies to the Royal and Oxford studies had lower rate ratios than the initial studies (1.3-1.1 and 1.6-1.3, respectively). The researchers identified only 9 studies (11 publications) which stood the test of critical appraisal with respect to internal validity. Analysis of these studies found more consistent result. OC use had a transient effect on the rate of gallbladder disease which depended on the estrogen dose. A dose-effect relationship with estrogen dose in 1 study revealed the relative risk for OCs with < 50 mcg estrogen to be 1, 11 for 50 mcg, and 1.2 for > 50 mcg (trend, p = .001), indicating that the modern low-dose OCs are safer than the older formulas. The dose-effect was more pronounced in younger women, who had used the modern low-dose OCs, and did not exist in older women, suggesting a transient effect. The pooling of 6 screening studies generated an odds ratio of 1.36 for ever OC users vs. never users. Further evaluations of the effect of OC use on gallbladder disease should look at bile saturation and biliary function.
Language: English
Keywords:
UNITED KINGDOM | NETHERLANDS | LITERATURE REVIEW | CROSS-CULTURAL COMPARISONS | FOLLOW-UP STUDIES | COHORT ANALYSIS | CASE CONTROL STUDIES | GALLBLADDER DISEASES | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, LOW-DOSE | ESTROGENS | BILIARY TRACT DISEASES | BIAS | SIDE EFFECTS | ADMINISTRATION AND DOSAGE | ORAL CONTRACEPTIVES, SIDE EFFECTS | Developed Countries | Europe, Western | Europe | Comparative Studies | Studies | Research Methodology | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Hormones | Endocrine System | Physiology | Biology | Error Sources | Measurement | Treatment | Drugs | Contraceptive Safety | Safety | Public Health | Health
Document Number: 084620

13.
Title: A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis.
Author: Basso L; McCollum PT; Darling MR; Tocchi A; Tanner WA
Source: SURGERY, GYNECOLOGY AND OBSTETRICS. 1992 Jul;175(1):41-6.
Abstract: In 1990, physicians used real time ultrasound scanning to examine the pelvic area and the upper part of the abdomen in a prospective study of 512 healthy, pregnant women (around 15.5 weeks gestation) attending the prenatal clinic at the Rotunda Hospital in Dublin, Ireland to determine the prevalence of gallstones. Most women also completed a questionnaire. Just 23 women (4.5%) had gallstones. 7 (30.4%) had earlier experienced a cholectectomy and another 2 (8.7%) had already been diagnosed with cholelithiasis. Thus, 14 (60.9%) pregnant women were unaware of the presence of gallstones. There was a higher proportion of women older than 30 years old with cholelithiasis than free of cholelithiasis (60.9% vs. 29.4%; p < .01). Women with gallstones were more likely to experience irregular, painful menstrual periods than the controls (30.4% vs. 15%; p < .05). Even though parity was not associated with cholelithiasis, the researchers observed a higher parity among symptomatic mothers than among asymptomatic mothers (2.8 vs. 1.1). This indicated that pregnancy may increase the prospect of symptoms in women who where unaware of the gallstones. Menarche, breast feeding, oral contraceptive use, and history of cholelithiasis were also not associated with gallstones. Yet, there was a positive trend of cholelithiasis in women who breast fed and in those who had a family history of gallstones. Further research is needed to investigate these 2 positive trends. These results indicated that real-time ultrasound scanning detected gallstones in 60.9% of pregnant women who did not know they had them. Thus, health providers should use this screening tool to also scan the upper part of the abdomen when scanning the pregnant uterus to detect the presence of asymptomatic cholelithiasis.
Language: English
Keywords:
IRELAND | RESEARCH REPORT | PROSPECTIVE STUDIES | CASE CONTROL STUDIES | GALLBLADDER DISEASES | PREGNANCY | PREGNANT WOMEN | DYSMENORRHEA | MATERNAL AGE | PARITY | MENARCHE | BREASTFEEDING | ORAL CONTRACEPTIVES | ULTRASONICS | SCREENING | WOMEN | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Diseases | Reproduction | Population Characteristics | Demographic Factors | Population | Menstruation Disorders | Parental Age | Age Factors | Fertility Measurements | Fertility | Population Dynamics | Menstruation | Infant Nutrition | Nutrition | Health | Contraceptive Methods | Contraception | Family Planning | Examinations and Diagnoses
Document Number: 076592

14.
Peer Reviewed

Title: Oral contraceptives and non-contraceptive oestrogens in the risk of gallstone disease requiring surgery.
Author: La Vecchia C; Negri E; D'Avanzo B; Parazzini F; Gentile A; Franceschi S
Source: JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH. 1992 Jun;46(3):234-6.
Abstract: Researchers compared June 1987-October 1990 data on 235 23-74 year old women diagnosed with gallstones and who required surgery at a variety of major teaching and general hospitals (many at Ospedale Maggiore) in metropolitan Milan, Italy with data on 538 21-74 year old women admitted for acute diseases other than digestive conditions to examine the link between combined oral contraceptives (COCs) and noncontraceptive estrogens and the risk of cholelithiasis. The women with gallstones tended to be overweight (age adjusted relative risk [AARR]=1.4) or obese (14.5% vs. 8.1%; relative risk [RR]=1.8; p for trend=.01). They also were more likely to be have =or> 4 children (7.7% vs. 3.9%). The proportion of cases under 60 years old who had ever used COCs and that of controls under 60 years, were essentially equal (17% vs. 15%, AARR=0.8). Duration of COC use was not linked to gallstone disease. Yet there was a slight increased risk for women who last used COCs <5 years before clinicians diagnosed cholelithiasis (RR=1.6). The risk fell to 0.4 for those who last used COCs =or> 5 years earlier than diagnosis, however. There was an insignificant increased risk of gallstone disease in cases who had undergone estrogen replacement therapy (8% vs. 5%; RR=1.7), but duration of use did not affect this risk. Yet the risk was greater for women who had last been treated with noncontraceptive estrogens at least 10 years before (2.3 vs. 1.1). This greater risk was not significant, however. These results confirmed those of other similar studies--neither COC use nor estrogen replacement therapy affect the development of cholelithiasis in individuals or on a public health scale.
Language: English
Keywords:
ITALY | METHODOLOGICAL STUDIES | CASE CONTROL STUDIES | GALLBLADDER DISEASES | ORAL CONTRACEPTIVES, COMBINED | ESTROGENS | RISK FACTORS | OBESITY | BODY WEIGHT | MULTIPARITY | SIDE EFFECTS | ORAL CONTRACEPTIVES, SIDE EFFECTS | Europe, Southern | Europe | Developed Countries | Studies | Research Methodology | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Hormones | Endocrine System | Physiology | Biology | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Treatment | Contraceptive Safety | Safety | Public Health | Health
Document Number: 077857

15.
Title: Oral contraceptives and skin neoplasia.
Author: Green A
Source: CONTRACEPTION. 1991 Jun;43(6):653-66.
Abstract: Evidence from case-control and cohort studies and animal research is reviewed to examine whether oral contraceptive (OC) use is related to cancer of the kidney, colon, rectum, gall bladder, extrahepatic bile ducts, benign or malignant pituitary tumors or prolactinemia. While animal research suggests possible hormone sensitivity, there are only 2 cohort studies available on renal adeno-carcinoma; result are contradictory. Colon and rectal cancer are sometimes studied separately and sometimes together despite different etiologic factors. Colon cancer is less common in women of higher parity, and associated with other female sex hormone related cancers. 3 case-control studies have produced no consistent results except for a possible higher risk of right colon cancer in OC users. Cohort studies on colorectal cancer resulted in very few cases and no significant increase in risk for these very common malignancies among OC users. Gallbladder cancer is associated with gallstones, a condition known to be enhanced by estrogens, yet 1 case-control study found no change in risk. In contract, cancer of the extrahepatic bile duct, usually more common in men, was found to be elevated in OC users in 1 small study. The question of pituitary tumors is complicated by difficulties in diagnosis, differentiating between hyperplasia, microadenomas, galactorrhea, prolactinemia and cycle irregularity. Basic research indicates that estrogens stimulate prolactin secretion and development of pituitary tumors. Yet of 6 case-control studies only 2 reported relative risks significantly above 1. Only 6 cases have been found in 3 large cohort studies. Therefore it is probable that any association of pituitary tumors with pills is largely due to their prescription for women with menstrual irregularity, some of whom had pre-existing pituitary adenomas.
Language: English
Keywords:
LITERATURE REVIEW | ORAL CONTRACEPTIVES | RISK ASSESSMENT | COHORT ANALYSIS | COMPARATIVE STUDIES | BILIARY TRACT DISEASES | GALLBLADDER DISEASES | NEOPLASMS, BENIGN | CANCER | PROLACTIN | PITUITARY GLAND | GASTROINTESTINAL EFFECTS | CHOLESTASIS | RISK FACTORS | PARITY | MENSTRUATION DISORDERS | CASE CONTROL STUDIES | COMPLICATIONS | Contraceptive Methods | Contraception | Family Planning | Evaluation | Research Methodology | Studies | Diseases | Neoplasms | Pituitary Hormones | Hormones | Endocrine System | Physiology | Biology | Hepatic Effects | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population
Document Number: 067164

16.
Title: A population-based case-control study of endometrial cancer in Shanghai, China.
Author: Shu XO; Brinton LA; Zheng W; Gao YT; Fan J; Fraumeni JF Jr
Source: INTERNATIONAL JOURNAL OF CANCER. 1991 Aug 19;49(1):38-43.
Abstract: A case-control study of 268 patients with endometrial cancer and 268 population controls was conducted during 1988-90 in Shanghai, China, to evaluate etiologic factors in a population whose risk had not been substantially altered by the use of exogenous estrogens. In spite of this, the major risk factors resembled those found in other studies. The risk of endometrial cancer was significantly elevated among nulligravidas (OR=5.4, 95% CI=2.0-14.6) and decreased with number of pregnancies (p<0.01). Late age at menopause was associated with increased risk, while early age at menarche was unrelated. Use of oral contraceptives (OCs) for more than 2 years was associated with a reduction in endometrial cancer risk (OR=0.4, 95% CI=0.1-1.2), while shortterm use of OCs and other methods of contraception were unrelated. Obesity was a strong predictor of risk, with women in the highest quartile of weight having 2.5 times the risk of those in the lowest quartile. In contrast to many other studies, cigarette smokers were at elevated risk (OR=1.7, 95% CI=0.9-3.0). Risk was also elevated among women reporting a history of gallbladder disease, polycystic ovaries, menstrual symptoms, and nonestrogen hormone use. (author's)
Language: English
Keywords:
CHINA | CASE CONTROL STUDIES | ENDOMETRIAL CANCER | RISK FACTORS | PARITY | MENOPAUSE | AGE FACTORS | ORAL CONTRACEPTIVES | OBESITY | TOBACCO USE | GALLBLADDER DISEASES | DATA COLLECTION | DEMOGRAPHIC FACTORS | MENSTRUAL CYCLE | Developing Countries | Asia, Eastern | Asia | Studies | Research Methodology | Cancer | Neoplasms | Diseases | Biology | Fertility Measurements | Fertility | Population Dynamics | Population | Reproduction | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Body Weight | Physiology | Behavior | Menstruation
Document Number: 068944

17.
Peer Reviewed

Title: The WHO Collaborative Study of Neoplasia and Steroid Contraceptives: the influence of combined oral contraceptives on risk of neoplasms in developing and developed countries.
Author: Thomas DB
Source: CONTRACEPTION. 1991 Jun;43(6):695-710.
Abstract: A hospital-based case-control study was conducted in 8 developing and 3 developed countries to determine whether use of combined oral contraceptives (OCs) alters risks of various cancers. An observed trend of increasing risk of invasive cervical cancer with duration of use may not represent a causal relationship and is the subject of further study. Decreased risks of ovarian and endometrial carcinomas in users likely indicate a protective effect of OCs, the degree of which was similar in developing and developed countries. A small increase in risk of breast cancer in recent and current users was found to be somewhat greater in developing countries. Both causal and noncausal interpretations of this finding have been offered. No associations were found between OCs and in situ cervical, hepatocellular, cholangio, or gallbladder carcinomas, or uterine sarcomas. However, the ability of this study to detect alterations in risks for these neoplasms in longterm users was low. (author's)
Language: English
Keywords:
DEVELOPED COUNTRIES | DEVELOPING COUNTRIES | ORAL CONTRACEPTIVES | CASE CONTROL STUDIES | HOSPITALS | HISTOLOGY | CERVICAL CANCER | RISK FACTORS | ENDOMETRIAL CANCER | UTERINE EFFECTS | OVARIAN CANCER | BREAST CANCER | LIVER NEOPLASMS | GALLBLADDER DISEASES | CANCER | NEOPLASMS | WHO | Contraceptive Methods | Contraception | Family Planning | Studies | Research Methodology | Health Facilities | Delivery of Health Care | Health | Biology | Diseases | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | UN | International Agencies | Organizations
Document Number: 067162

18.
Peer Reviewed

Title: Effects of steroidal contraceptives on gallbladder: a review.
Author: Kenya PR
Source: East African Medical Journal. 1990 Sep;67(9):661-6.
Abstract: More than 10 controlled epidemiologic studies are reported and reviewed in this paper which examine gallbladder disease and oral contraceptive (OC) use. Findings concerning an association between the 2 are contradictory. OC use and the use of estrogens in postmenopausal women have been reported to be associated with increased attack rates of gallbladder disease, but the increased risk in higher in those women using estrogens than progestin-based OCs. Other studies, however, have reported little overall effect of OC use on the development of gallbladder disease. Where increased risk has been documented, it has been related more to duration. The increased risk of gallbladder disease related to OC use has been observed to be higher within the 6-12 month range of usage. Only 1 study reported increased risk of gallbladder disease in longterm users. The increase may be greater in multiparae than nulliparae; pregnancy and obesity may also pose an increased risk to the disease in OC users. However, these findings are not widely accepted. (author's modified)
Language: English
Keywords:
ORAL CONTRACEPTIVES | GALLBLADDER DISEASES | RISK FACTORS | PARITY | INCIDENCE | DATA ANALYSIS | OBESITY | PREGNANCY | Contraceptive Methods | Contraception | Family Planning | Diseases | Biology | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Measurement | Research Methodology | Body Weight | Physiology | Reproduction
Document Number: 066389

19.
Peer Reviewed

Title: [Ovulation inhibitors: the significance of the estrogen dose] Ovulationshemmer: die Bedeutung der Ostrogendosis.
Author: Kuhl H
Source: GEBURTSHILFE UND FRAUENHEILKUNDE. 1990 Dec;50(12):910-22.
Abstract: The large prospective studies on adverse effects of oral contraceptives (OCs) have unanimously revealed an increases risk of thromboembolic disease which seems to be related to dosage of ethinyl estradiol (EE). According to the recommendations of several medical committees, EE dosages have thus been reduced; in some countries, there are ovulation inhibitors which contain 20 mcg EE. Since serious reactions are relatively underreported (although they occur in less than 10% of the cases), it is difficult to prove dose-dependent differences in the rates of cardiovascular disease. There is , however, virtually no doubt that not only the incidence of thromboembolic disease and stroke, but also that of benign liver tumors and gallbladder disease, is increased in relation to EE dose. A series of metabolic serum parameters, e.g., serum binding proteins, coagulation and fibrinolysis factors, and angiotensin, is changed by EE in a dose-dependent manner which is limited when the effects are receptor-mediated. Higher doses of EE have been shown to facilitate fibrin deposits on vascular subendothelium. The pharmacological effects of EE are largely dependent on dose, e.g., the irreversible reactions of EE and other ethinylated steroids with hepatic enzymes which are involved in the metabolism of steroids, drugs, and toxic compounds. After longterm treatment with combinations containing 50 mcg EE, abnormal liver function tests with pathological morphological alterations were found in 1/2 of the women. Since combinations with low EE doses and a sufficiently effective progestogen component do not differ from higher-dosed OCs insofar as safety and cycle control are concerned, there are no indications for pills containing 50 mcg EE, except for the normophasic sequential preparations for women with sustained irregular bleedings during ingestion of low-dose combinations. (author's modified) (summaries in GER, ENG)
Language: German
Keywords:
ETHINYL ESTRADIOL | RISK FACTORS | THROMBOEMBOLISM | GALLBLADDER DISEASES | HEPATIC EFFECTS | CEREBROVASCULAR EFFECTS | INCIDENCE | CARDIOVASCULAR EFFECTS | ADMINISTRATION AND DOSAGE | CHANGES | SIDE EFFECTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | WOMEN | Contraceptive Agents, Estrogen | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Biology | Embolism | Vascular Diseases | Diseases | Physiology | Measurement | Research Methodology | Drugs | Treatment | Social Change | Demographic Factors | Population
Document Number: 067047

20.
Title: Risks of estrogens and progestogens.
Author: L'Hermite M
Source: MATURITAS. 1990 Sep;12(3):215-46.
Abstract: The risks and benefits of specific types of postmenopausal estrogens and progestogens are explored: those affecting serum lipids, clotting elements, hepatic proteins synthesis, blood pressure, glucose tolerance, endometrial, breast and cervical cancer. Ethinyl estradiol taken orally is the only estrogen likely to cause gall bladder disease. It also induces liver protein synthesis when taken orally or vaginally. Natural estrogens do not heighten coagulation factors, and may shift towards fibrinolysis. Both ethinyl estradiol and equine estrogens may increase blood pressure, while natural estrogens may decrease it. Similarly natural estrogens induce prostacyclin synthesis, while ethinyl estradiol activates both prostacyclin and thromboxanes. Progestagens, especially so the norprogestins, disturb carbohydrate metabolism and tend to reverse the beneficial effects of estrogens on serum lipids, a 40-70% reduction in risk of mortality from coronary heart disease. A meta- analysis of 23 studies concluded that menopausal estrogens do not increase the risk of breast cancer by a measurable degree, except in high doses and in those predisposed by family history. There is an increased risk of endometrial carcinoma for those taking unopposed estrogens for more than 3-6 years. This can be attenuated by taking combined estrogen-progestins, which will eventually result in absence of bleeding, or a 12-day progestogen course every 4-6 cycles. Oral micronized progesterone decreases blood pressure. The relative androgenic effects of progestins other than the norprogesterone derivatives are less significant. As an alternative to taking a progestogen, a woman could have regular endometrial sampling or abdominal or vaginal sonograms to detect endometrial cancer.
Language: English
Keywords:
LITERATURE REVIEW | MENOPAUSE | ESTRADIOL | ESTRIOL | ESTRONE | CONJUGATED ESTROGENIC SUBSTANCES | CHLORMADINONE ACETATE | ETHINYL ESTRADIOL | MEDROXYPROGESTERONE ACETATE | LEVONORGESTREL | LYNESTRENOL | NORETHINDRONE | GALLBLADDER DISEASES | CARDIOVASCULAR EFFECTS | CEREBROVASCULAR EFFECTS | HYPERTENSION | THROMBOEMBOLISM | SERUM PROTEIN EFFECTS | GLUCOSE METABOLISM EFFECTS | LIPID METABOLIC EFFECTS | BREAST CANCER | ENDOMETRIAL CANCER | MORTALITY | RISK FACTORS | DESOGESTREL | GESTODENE | NORGESTIMATE | CYPROTERONE ACETATE | WOMEN | Reproduction | Estrogens | Hormones | Endocrine System | Physiology | Biology | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Agents, Estrogen | Diseases | Vascular Diseases | Embolism | Hematological Effects | Hemic System | Carbohydrate Metabolic Effects | Metabolic Effects | Lipids | Cancer | Neoplasms | Population Dynamics | Demographic Factors | Population | Hormone Antagonists
Document Number: 064559

21.
Title: [Prevalence of cholelithiasis in relation to use of hormonal contraceptives] Pravalenz der Cholelithiasis in Abhangigkeit von der Einnahme hormonaler Kontrazeptiva (HK).
Author: Pannwitz H; Berndt H; Nurnberg D
Source: GASTROENTEROLOGISCHES JOURNAL. 1990;50(2):78-81.
Abstract: 400 women regularly using oral contraceptives (OC) were examined by standard sonography for signs of gall stones (GS). In the 61 (15.25%) who had GS, the prevalence was age dependent: up to age 24 the rate was 5.9%, it was almost 20% in the 25-44 age group, and it reached 30.2% in the 45-54 age group. Among 130 nulliparous women, 4 had GS (3.1%); among 71 with 1 delivery, 11 had GS (15.5%); and among 199 of those with 2 or more deliveries, 47 had GS (23.1%). Nulliparous women in all age groups had a much lower rate of GS incidence. GS prevalence was highest in women who had had multiple deliveries and were of a more advanced age (45-54). 19.6% of those up to age 24 used OCs for <1 year, and 3.6% used OCs >5 years, while in the 45-54 age group, 81.1% used OCs for >5 years. The number of GS carriers increased in proportion to duration of OC use. 4 of 130 mostly young nulliparas used OC for 1-5 years. All 11 (15.5%) GS carriers among the 71 women with 1 delivery used OCs for >1 year, and 7 used them for >5 years. 23% of multiparous women had GS (46 out of 199), and 36 used OCs >5 years. The effect of pregnancy is very clear when the nulliparous GS rate (3.1%) is compared to the rate of all parous women (15.9%, or 43 out of 270). None of the 61 women with GS had taken OCs for <1 year, 70.5% had taken them for >5 years, and 29.5% had taken them for 2-5 years. However, after taking other factors into consideration, it must be stated that OC use affects the incidence of GS not at all or only marginally.
Language: German
Keywords:
GERMANY | ORAL CONTRACEPTIVES | GALLBLADDER DISEASES | AGE FACTORS | MULTIPARITY | NULLIPARITY | WOMEN | Europe, Central | Europe | Developed Countries | Contraceptive Methods | Contraception | Family Planning | Diseases | Population Characteristics | Demographic Factors | Population | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 065740

22.
Peer Reviewed

Title: Combined oral contraceptives and gallbladder cancer.
Author: World Health Organization [WHO]. Collaborative Study of Neoplasia and Steroid Contraceptives
Source: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 1989 Jun;18(2):309-14.
Abstract: The relationship between combined oral contraceptives (OCs) and primary gallbladder cancer was examined in 58 cases and 355 controls participating in an international hospital-based, case-control study. Use of combined OCs at any time was not associated with the risk of developing gallbladder cancer (RR=0.6, 95% CI 0.3, 1.3), and no clear patterns of risks were observed according to the duration of use, or time since 1st or most recent use. There was also no evidence that OCs effected risk of gallbladder cancer in women with or without a prior history of gallbladder disease. A history of gallbladder disease or gallstones was a strong risk factor or gallbladder cancer (RR+2.3, 95% CI 1.2, 4.4). (author's)
Language: English
Keywords:
GALLBLADDER DISEASES | ORAL CONTRACEPTIVES, COMBINED | CANCER | CASE STUDIES | CONTROL GROUPS | RISK FACTORS | DATA ANALYSIS | POPULATION CHARACTERISTICS | POPULATION AT RISK | SIDE EFFECTS | ORAL CONTRACEPTIVES, SIDE EFFECTS | Diseases | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Neoplasms | Studies | Research Methodology | Biology | Demographic Factors | Population | Treatment | Contraceptive Safety | Safety | Public Health | Health
Document Number: 059148

23.
Title: Epidemiologic assessment of effects of steroidal contraceptives on the liver and gallbladder.
Author: Kenya PR
Source: In: Safety requirements for contraceptive steroids. Proceedings of a Symposium on Improving Safety Requirements for Contraceptive Steroids convened by the WHO Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, February 1987, edited by F. Michal. Cambridge, England, Cambridge University Press, 1989. :97-112.
Abstract: Epidemiologic studies on the effects of steroidal contraceptives and the development of hepatic tumors and gallbladder disease have reported contradictory results. Some of the studies on these subjects have found an association between oral contraceptive (OC) use and hepatic tumors and gallbladder disease, whereas other studies have failed to demonstrate such a relationship. Most of these studies have suffered from inherent deficiencies in study designs common to retrospective longitudinal investigations. In some studies, the lack of close patient matching for age and other confounding factors were prominent. Also, comparable degrees of historical ascertainment for case and control groups was another biasing feature. Because of these and other methodological limitations and lack of statistical power in some of the available studies on these subjects to date, more studied with appropriate methodological designs and statistical power are needed to definitively elucidate on the role of steroidal contraceptives on the incidence of liver tumors and gallbladder disease. Therefore, due to their various weaknesses, the current studies do not provide adequate data to incriminate steroidal contraceptives in the occurrence of liver tumors and gallbladder disease, and should thus be interpreted cautiously. (author's)
Language: English
Keywords:
EPIDEMIOLOGIC METHODS | HEPATIC EFFECTS | GALLBLADDER DISEASES | RISK FACTORS | INCIDENCE | CONTROL GROUPS | AGE DISTRIBUTION | LITERATURE REVIEW | ORAL CONTRACEPTIVES, SIDE EFFECTS | FEMALE CONTRACEPTION | CONTRACEPTIVE METHODS | SIDE EFFECTS | Research Methodology | Physiology | Biology | Diseases | Measurement | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Safety | Safety | Public Health | Health | Contraception | Family Planning | Treatment
Document Number: 062587

24.
Title: The influence of pregnancy and contraceptive steroids on the biliary tract and its reference to cholesterol gallstone formation.
Author: Radberg G; Friman S; Svanvik J
Source: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. 1989;25(2):97-102.
Abstract: The evidence that pregnancy and the use of contraceptive steroids are associated with increased risk of cholesterol gallstones is reviewed from a physiologic viewpoint. Hepatobiliary functions known to be involved in gallstone formation are physical and chemical composition of bile; nucleation, retention and crystal growth; decreased gallbladder motility; enterohepatic circulation of bile acids; speed of gastric emptying and intestinal transit time. In pregnancy many changes in bile acid concentration and pool size have been documented in animals and women, with conflicting results. Late pregnant women have enlarged gall bladders that empty slowly in response to food, and prolonged intestinal transit time, but not gastric emptying, has been reported. Cholesterol saturation of bile is increased. Estrogens are known to bind to receptors in hepatocytes and gall bladder. During estrogen administration, cholesterol saturation in bile increases, the bile acid pool size decreases, synthesis of bile acids declines and recycling of bile acids increases, with increased fecal losses of bile acids. Progestins have the opposite effects, favoring bile acid synthesis. Progesterone has a quieting effect on smooth muscle, possibly causing some of the complaints of pregnancy and oral contraception such as heartburn and constipation. These changes, with the possibility that emptying of the gall bladder is incomplete, give cause for the association between oral contraception and gallstones.
Language: English
Keywords:
LITERATURE REVIEW | ESTROGENS | PROGESTATIONAL HORMONES | ORAL CONTRACEPTIVES | GASTROINTESTINAL EFFECTS | HEPATIC EFFECTS | CHOLESTEROL | LIPID METABOLIC EFFECTS | MATERNAL PHYSIOLOGY | BILIARY TRACT DISEASES | GALLBLADDER DISEASES | PREGNANCY COMPLICATIONS | COMPLICATIONS | Hormones | Endocrine System | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning | Lipids | Diseases
Document Number: 066546

25.
Title: Oral contraceptives and gallstones [letter]
Author: Bateson MC
Source: Lancet. 1988 May 14;1(8594):1115-6.
Abstract: Your editorial (April 16, p 861) suggests that oral contraceptives (OCs) cause gallstones. However, review of the evidence shows they do not, and also shows no causative role for hormone replacement therapy. The only drug unequivocally known to induce gallstones is clofibrate, though the other fibric acid analogues are also under suspicion. Attention should be concentrated on the real female risk factors. Multiple pregnancies, abortions, and early menarche lead to a greater risk of cholelithiasis, and could explain why women get more gallstones than men. Eating meat is also a factor, since vegetarian women have only 1/2 the gallstone prevalence of omnivores. We do not understand the mechanisms involved, and this is where attention and research should focus. (full text)
Language: English
Keywords:
ORAL CONTRACEPTIVES | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | GALLBLADDER DISEASES | BILIARY TRACT DISEASES | DISEASES | RISK FACTORS | WOMEN | Contraceptive Methods | Family Planning | Contraceptive Agents | Biology | Demographic Factors | Population
Document Number: 049306

26.
Title: Risks and benefits of oral contraceptive use in women over 35.
Author: Cramer DW; Cann CI
Source: MATURITAS. 1988;Suppl 1:99-109.
Abstract: The majority of epidemiological studies on the benefits and risks of oral contraceptive (OC) use have been conducted during the late 1960s and early 1970s when OCs had >50 mcg of estrogen. Based on these studies, the risk of death due to OC use for nonsmokers 35-39 years old was lower than using no contraceptive at all (14.1 deaths/100,000 women/year vs. 25.7 deaths/100,000 women/year). In addition to smoking, other contraindications include women with a history of angina, myocardial infarction, blood clots or stroke, estrogen dependent cancer, hypertension, a known lipid disorder, and women with hepatitis or cirrhosis of the liver. Suitable > 35 year old candidates for OC use would be nonsmokers with blood group O, at low risk for cardiovascular disease, and who might receive additional benefits, including those with severe dysmenorrhea or hypermenorrhea and possibly those who have a strong family history of osteoporosis, early menopause, or ovarian cancer. Practitioners should take a thorough history of these women and give a physical examination with a blood pressure check. They should also administer screening tests, such as a PAP test, mammograms, a lipoprotein profile, and a glucose test. After the practitioners have deemed these women to be healthy based on the examination and the results of the screening test, they then should prescribe only a low dose OC containing < 50 mcg of estrogen. Today most estrogen based OCs contain 35 mcg and research on their effects have not yet begun. Scientists expect to find that the dose response effects for risks for thromboembolism, myocardial infarction, stroke, and gallbladder disease to be lower in users of the low dose preparations.
Language: English
Keywords:
LITERATURE REVIEW | TOBACCO USE | ORAL CONTRACEPTIVES | ORAL CONTRACEPTIVES, CONTRAINDICATIONS | ORAL CONTRACEPTIVES, SIDE EFFECTS | HIGH RISK WOMEN | GALLBLADDER DISEASES | MYOCARDIAL INFARCTION | HYPERTENSION | THROMBOEMBOLISM | METABOLIC EFFECTS | NEOPLASMS | RISK FACTORS | CONTROL GROUPS | COHORT ANALYSIS | AGE FACTORS | CONTRAINDICATIONS | SIDE EFFECTS | Behavior | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Public Health | Health | Reproduction | Diseases | Heart Diseases | Vascular Diseases | Embolism | Physiology | Biology | Research Methodology | Population Characteristics | Demographic Factors | Population | Treatment
Document Number: 057056

27.
Title: Contraceptive steroids alter the steady-state kinetics of bile acids.
Author: Everson GT; Fennessey P; Kern F Jr
Source: JOURNAL OF LIPID RESEARCH. 1988 Jan;29(1):68-76.
Abstract: Contraceptive steroids increase the ratio of cholic acid to chenodeoxycholic acid in bile. This alteration may contribute to the development of cholesterol gallstones. The objective of this study was to measure the effects of contraceptive steroids on bile acid kinetics and to relate them to changes in cholesterol metabolism. Steady-state kinetics of bile acids were measured in 15 healthy women, on and off contraceptive steroids. Cholic acid synthesis increased 30.3% (P0.025) and its pool increased by 37.4% (P0.025). Chenodeoxycholic acid synthesis decreased 6.4% (P=0.08) and its pool decreased by 11.8% (P0.05) during use of contraceptive steroids. The fractional turnover rates of both primary bile acids did not change. The changes in kinetics of the primary bile acids were related to alterations in biliary lipid and cholesterol metabolism, separately reported (J. Lipid Research 1987, 28: 828-839). During the use of contraceptive steroids, total bile acid pool and total bile acid synthesis correlated directly with cholesterol synthesis, assayed in mononuclear leukocytes (r=0.50 and r=0.54, respectively) but not with the plasma clearance of chylomicron remnants, measured with retinyl palmitate. The data indicate that contraceptive steroids directly alter the hepatic synthesis of bile acids and suggest that newly synthesized cholesterol may be a preferred substrate for bile acid synthesis during use of contraceptive steroids. (author's)
Language: English
Keywords:
COLORADO | UNITED STATES OF AMERICA | NORTH AMERICA | AMERICAS | GALLBLADDER DISEASES | BILIARY TRACT DISEASES | DISEASES | RISK FACTORS | HEPATIC EFFECTS | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | LABORATORY PROCEDURES | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | LIPID METABOLIC EFFECTS | METABOLIC EFFECTS | MEASUREMENT | CHANGES | ANALYSIS | CONTRACEPTIVE METHODS | SIDE EFFECTS | Developed Countries | Developing Countries | Biology | Physiology | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Family Planning | Lipids | Research Methodology | Social Change | Treatment
Document Number: 055567

28.
Title: Gall stones in a Danish population: fertility period, pregnancies, and exogenous female sex hormones.
Author: Jorgensen T
Source: GUT. 1988 Apr;29(4):433-9.
Abstract: The possible association between ultrasonography-confirmed gall stone disease and menarche, menopause, pregnancies, breastfeeding, abortion, and exogenous female sex hormone use was investigated in a cross-sectional study. Study subjects included 1765 Danish women aged 30-60 years. Gall stone disease was significantly associated with a younger age at menarche, abortions, and multiple childbirth. Use of oral contraceptives (OCs) was significantly associated with gall bladder disease in the univariate analysis, but not in the multivariate analysis. Breastfeeding, age at menopause, and hormonal therapy during menopause were not significantly linked to gall bladder disease. The determining variables identified in this study help to explain the higher prevalence of gall stone disease in women than in men during the childbearing years. Both before puberty and after menopause, there is no sex differential in terms of the incidence of gall stone disease. Overall, the number of pregnancies and the length of the fertility period seem to be the most significant factors in the development of such disease.
Language: English
Keywords:
CORRELATION STUDIES | GALLBLADDER DISEASES | BILIARY TRACT DISEASES | DISEASES | RISK FACTORS | MENARCHE | ORAL CONTRACEPTIVES | MULTIPARITY | SEX FACTORS | AGE FACTORS | Statistical Studies | Studies | Research Methodology | Biology | Menstruation | Reproduction | Contraceptive Methods | Contraception | Family Planning | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Population Characteristics
Document Number: 055879

29.
Title: Oral contraceptives and gallstones [letter].
Author: Jorgensen T
Source: Lancet. 1988 Aug 6;2(8606):335-6.
Abstract: This letter was written in response to another investigator who cited the author's work. The investigator states that oral contraceptives do not cause gallstones, citing the author's work. The author responds that his work does not provide sufficient data for such a statement. The author's study showed a significant association between oral contraceptives and gallstones by univariate analysis (p0.05) but p changed to 0.09 in the multivariate analysis taking pregnancies, age at menopause, and familial occurrence of clinical gallstones into account. The odds ratio changed from 1.47 to 1.38. This change was not large and even if no dose-response effect among users was seen, these data do not rule out an association between gallstones and oral contraceptives. One must remain suspicious until the results of properly conducted studies which measure the overall incidence of gallstone disease among users and non-users of oral contraceptives are in.
Language: English
Keywords:
DENMARK | EUROPE, WESTERN | EUROPE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION | GALLBLADDER DISEASES | BILIARY TRACT DISEASES | DISEASES | CRITIQUE | CONTRACEPTIVE METHODS | SIDE EFFECTS | Europe, Northern | Developed Countries | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents | Family Planning | Treatment
Document Number: 063178

30.
Title: Increased risk of cholecystectomy in users of supplemental estrogen.
Author: Petitti DB; Sidney S; Perlman JA
Source: GASTROENTEROLOGY. 1988 Jan;94(1):91-5.
Abstract: The association between cholecystectomy and use of supplemental estrogen was examined in a prospective cohort study of 16,638 women aged 18-54 years enrolled in California's Kaiser-Permanente Medical Care Program. The results provided further evidence for an association between use of contraceptive estrogens at any time and the risk of cholecystectomy. There were 55 cholecystectomies in the 3339 women who had never used estrogen and 105 in the 2525 women who had ever used estrogen. 98% of the cholecystectomies were for cholelithiasis. After adjustment for age, the relative risk of cholecystectomy in women who had ever used estrogen was 2.1 (95%) confidence interval, 1.5-3.0). In women defined as current users (on the basis of information available in 1977), the relative risk of gallbladder disease was 2.7 (95% confidence interval, 1.8-4.0) compared with 1.6 (95% confidence interval 1.1-2.5) in past users. However, when women known to have reinitiated estrogen use after 1977 were removed from the numerator for past use and added to the numerator for current users, the relative estimate for past use decreased to 1.1 (95% confidence interval, 0.7-1.8) and the risk estimate for current use increased to 3.9 (95% confidence interval, 2.6-5.9). These data thus suggest that the risk of gallbladder disease in estrogen users persists after cessation of use. It is hypothesized that estrogen-induced increases in the lithogenicity of bile cause gallstones to form during estrogen use. If these gallstones fail to dissolve even after bile lithogenicity returns to normal when estrogen use is discontinued, cholecystectomy will be necessary. The effect of estrogen use on the gallbladder should be given more serious consideration in weighing the net risk-benefit ratio of these drugs.
Language: English
Keywords:
PROSPECTIVE STUDIES | GALLBLADDER DISEASES | BILIARY TRACT DISEASES | DISEASES | ESTROGENS | HORMONES | REPRODUCTIVE CONTROL AGENTS | RISK FACTORS | SIDE EFFECTS | Studies | Research Methodology | Endocrine System | Physiology | Biology | Family Planning | Treatment
Document Number: 056247


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