Oral contraceptives hormonal side-effects

Drugs with endocrinological functions or side-effects are common, but oestrogenic hormones in oral contraceptives are particularly widely used. Pharmaceuticals and their metabolites eventually find their way into the environment, predominantly via excretion into sewage. ... 

Sustained- and controlled-release devices for drug delivery in the vaginal and uterine areas are most often for the delivery of contraceptive steroid hormones. The advantages in administration by this route—prolonged release, minimal systemic side effects, and an increase in bioavailability—allow for less total drug than with an oral dose. First-pass metabolism that inactivates many steroid hormones can be avoided [183,184],... 

The hormone-releasing devices have a closer resemblance to standard methods of sustained release because they involve the release of a steroid compound by diffusion [198,199]. The Progestasert, a reservoir system, is shown in Fig. 16. Progesterone, the active ingredient, is dispersed in the inner reservoir, surrounded by an ethylene/vinyl acetate copolymer membrane. The release of progesterone from this system is maintained almost constant for 1 year. The effects of release are local, with none of the systematic side effects observed with orally administered contraceptives [200-207]. 

All medical therapies (nonsteroidal anti-inflammatory drugs, oral contraceptives, progestins, danazol, or gonadotropinreleasing hormone agonists) are equally efficacious in treating endometriosis-related pain based on available evidence. Choice among agents is determined primarily by side-effect profile, cost, and individual patient response. 

Modern oral contraceptives can contribute to the incidence and severity of certain diseases if other risk factors are present. The following conditions are considered absolute contraindications for combination oral contraceptives the presence or history of thromboembolic disease, cerebrovascular disease, myocardial infarction, coronary artery disease, or congenital hyperlipidemia known or suspected carcinoma of the breast, carcinoma of the female reproductive tract, or other hormone-dependent/responsive neoplasias abnormal undiagnosed vaginal bleeding known or suspected pregnancy and past or present liver tumors or impaired liver function. The risk of serious cardiovascular side effects is particularly marked in women over 35 years of age who smoke heavily (e.g., >15 cigarettes/day) even low-dose oral contraceptives are contraindicated in such patients. 

Von Eickstedt K-W (1980) Miscellaneous hormones. In Dukes MNG (ed) Meyler s side effects of drugs. Excerpta Medica, Amsterdam London New York, pp 719-726 Wolf RL (1967) Angioneurotic edema from an oral contraceptive. JAMA 201 162... 

The most fundamental societal change remained however reserved to the discovery of the pill . In times of economic awakening, student upheaval, women s emancipation movement, hippie culture, liberalisation in the Roman Catholic Church (in the wake of the 2nd Vatican Council, 1962-1965) and sexual laxity, the first hormonal oral contraceptives came on the market. In 1964, 2% of the women of child-bearing age took ovulation inhibitors by 1968, this number had already increased to 12 %, and by 1986, to more than 35 %. Nowadays, the pill is ranked as one ofthe safest contraceptives. Not only the active ingredients were improved, but also their dosages and dosing schedules. Through the experience over the last 30 years with many millions of women on the pill , the associated risks and side-effects are now well-known. 

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