Thromboembolic Disease and the Steroidal Content of Oral Contraceptives. A Report to the Committee on Safety of Drugs

Inman, W. H. W.; Vessey, Martin; Westerholm, B; Engelund, A.

doi:10.1136/bmj.2.5703.203

Cited by 579 publications

(122 citation statements)

References 9 publications

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“…Because the intravascular coagulation and the activity of several clotting factors appear to be estrogen dose dependent,26-28 this decline has probably resulted in a decline in the incidence of adverse cardiovascular events associated with oral contraceptive use. [29][30][31] The correlation between age and high-dose estrogen oral contraceptives seen in the past32 has almost disappeared. For the most part, women of older reproductive age who choose to use oral contraceptives have taken advantage of the risk reductions associated with low-dose estrogen formulations.…”

Section: Resultsmentioning

confidence: 99%

Trends in the content and use of oral contraceptives in the United States, 1964-88.

Gerstman¹,

Gross²,

Kennedy³

et al. 1991

Am J Public Health

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Drug marketing and physician survey data were used to examine trends in the use and hormonal content of oral contraceptives in the United States between 1964 and 1988. Retail prescriptions for oral contraceptives peaked at approximately 68 million in 1973 and have remained between 50 million and 60 million since 1981. Despite this relative consistency in the number of prescriptions, physician "mentions" of oral contraceptives have increased by approximately 75 percent. This increase may reflect closer monitoring of women on oral contraceptives. Use of multiphasic formulations has steadily risen, accounting for 37 percent of the oral contraceptive prescriptions in 1988. Mean estrogen and progestin doses in all types of formulations have steadily declined. A change in the type of estrogen and progestin used in preparations has coincided with this decline in dose. The association between age and use of high-dose formulations seen in the past was no longer evident in 1988. The data demonstrate that oral contraceptive formulations in wide use today differ in hormone content from those of the past, when most of the major studies addressing the risks associated with oral contraceptive use were completed. There is therefore a need to determine the risks and long-term effects associated with these newer formulations.

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Section: Resultsmentioning

confidence: 99%

Trends in the content and use of oral contraceptives in the United States, 1964-88.

Gerstman¹,

Gross²,

Kennedy³

et al. 1991

Am J Public Health

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show abstract

“…Although this complication has fortunately not been observed in any of our patients treated with large doses of Provera, in view of possible changes in the aorta and also the risk of thrombo-embolic disorders related to the progestational component of contraceptive pills (Inman et al, 1970), special attention should be given to the cardiovascular system in advanced cancer cases treated with large doses of progestins that come to autopsy.…”

Section: Discussionmentioning

confidence: 80%

Medroxyprogesterone Acetate (Provera) in the Treatment of Metastatic Renal Cancer

Bloom¹

1971

Br J Cancer

100

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SUMMARY.-Eighty patients with advanced metastatic renal cancer have been treated with hormones, chiefly medroxyprogesterone acetate (Provera). This progestational compound is remarkably free from side-effects and can be given in high dosage for long periods without serious complications. Ninety per cent of cases had multiple metastases: in 76% more than one organ was involved and nearly 50% were seriously ill or " terminal ".Subjective improvement occurred in at least 55%. BETWEEN 75% and 80% of patients treated for renal cell carcinoma will die within 10 years of their primary treatment, the majority with distant metastases. In a few of these cases the natural history of the disease will be unusual. For example, growth of metastases may be exceptionally slow or, following removal of a solitary lesion, the patient may live for a number of years without further recurrence. Very rarely spontaneous regression of pulmonary deposits may occur. For the vast majority of cases, however, the onset of clinical metastases heralds death within a year or two. The treatment of advanced renal cancer with cytotoxic drugs has been disappointing. Woodruff et al. (1967) reviewed the literature on this subject, and of 243 collected cases treated with 33 different non-hormonal agents only 10% showed signs of objective improvement: in most instances this was slight or of brief duration. Talley et al. (1969) have published their personal experience with various cytotoxic drugs against metastatic hypernephroma. Of 57 patients treated with 15 different non-hormonal compounds, chiefly alkylating agents, antimetabolites and vinblastine, objective improvement was seen in only two cases (3.50 %). Apart from these poor results, the agents employed are highly toxic and have a relatively small margin of safety.

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“…Thus, when clot forms, they may be less likely to dissolve and more likely to reach a size sufficient to block vessels and create a thromboembolic problem. The increased risk of venous thrombosis and pulmonary embolism is probably attributable in some women to the estrogencontent of their oral contraceptives.A positive correlation was found by Inman et al in United Kingdom between the risk of thromboembolic disease and the dosage of estrogen contained in OCP, when combined OCP containing high doses (75-100 ìg or more) of estrogen, were available at that time were used 19 . The availability of new generation monophagic and multiphagic formulations of OCP containing both low dose of estrogen and new progestogen has virtually changed the previous idea of thrombogenic effect of OCP 20,21 .…”

Section: Discussionmentioning

confidence: 83%

Effect of Low Dose Oral Contraceptive Pill on Coagulation Status in Women with Normal and Low Body Mass Index

Kasem¹,

Chowdhury²,

Razzaque³

et al. 2017

J. Bangladesh Coll. Phys.

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Thromboembolic Disease and the Steroidal Content of Oral Contraceptives. A Report to the Committee on Safety of Drugs

Cited by 579 publications

References 9 publications

Trends in the content and use of oral contraceptives in the United States, 1964-88.

Trends in the content and use of oral contraceptives in the United States, 1964-88.

Medroxyprogesterone Acetate (Provera) in the Treatment of Metastatic Renal Cancer

Effect of Low Dose Oral Contraceptive Pill on Coagulation Status in Women with Normal and Low Body Mass Index

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