Search

Despite more than 30 years' experience with the pill, being by far the most thoroughly studied drug ever, we must conclude that there still is a remarkable paucity of data that would allow us to assess unambiguously its margins of efficacy. The physiological studies on which we must rely encompass limited numbers of subjects and are unlikely to include sufficient representatives of the vulnerable minority of women that really matter. Even though we realise that this vulnerable minority is there, we still cannot do better than to hypothesise about their characteristics, let alone identify them in advance. This lack of knowledge has contributed to the existence of diverging views on how to advise the general population of pill takers about missed tablets. Against this background, we felt there was a need to make an inventory of the existing data and, subsequently, to incorporate them in advice that in our opinion is most appropriate in the current state of knowledge. We have come to the conclusion, in contrast to what is often held, that it is not the number of tablets missed, but rather the timing relative to the pill-free interval that determines the impact of noncompliance. We further conclude that shortening of the pill-free interval to five or six days could substantially improve the efficacy of the pill: at the low doses currently used in oral contraceptives the total steroid burden would not be substantially increased, while still allowing withdrawal bleeding to occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective To assess compliance with recommendations for hormone replacement therapy (HRT) in postmenopausal women following screening for osteoporosis. Design A postal questionnaire sent to women an average of 8 months (range 6–12) following measurement of their bone mineral density (BMD), and recommendations regarding HRT given to the referring general practitioner. Setting Referrals from local general practitioners. Mixed social class. Subjects 400 postmenopausal women aged 40–69 years (average age 52). Main outcome measures Compliance with advice and if failing to comply, reasons for not doing so. Results Replies were received from 352 women (88%) and 74% of respondents followed advice to start, continue, or refrain from starting or continuing HRT with regard to protecting their skeleton. Those who rejected advice to take HRT mostly had concern over side effects or the efficacy or safety of treatment. Of the women who started HRT 28% subsequently stopped, the principal reasons being withdrawal bleeding and weight gain. Of the women recommended to take HRT, 39% were not taking treatment by 8 months after referral, either because they ignored advice given (22%) or because of side effects (17%). Conclusions Screening leads to increased usage of HRT among women at most risk for osteoporosis. However, almost 40% of women with low bone mineral density were not taking HRT 8 months after referral, and therefore until improved compliance has ben demonstrated screening cannot be widely recommended.

This report describes the time-interval between the last withdrawal bleeding and the first 2 or 3 spontaneous menstrual periods in 516 women who had used combined oral contraceptives for periods of 9 to 55 months. The first 300 patients applying for renewal of their prescriptions for oral contraceptives were recommended to withold the medication until they had had 2 spontaneous menstrual periods. Later 216 women were asked to wait for 3 spontaneous menstrual periods. Although several combined oral contraceptives had been used 77.5% had taken Conluten which is norethindron 2 mg and mestranol .1 mg. In 1 group patient menstrual cycles had been regular and of about 1 month duration before taking the contraceptive. In a second group periods had been irregular. In a third group periods had been regular but of unusually short or long duration. During the observation time 17 pregnancies occurred. In most of those who had usually had regular periods the first menstrual cycle after stopping therapy was about 6 days longer than the following ones which were the same as before therapy. Of the 515 subjects 4 developed amenorrhea lasting more than 180 days. Of these 3 had had irregular menstrual periods before using contraceptives. It is therefore recommended that combined oral contraceptives be used with caution in women who have irregular menstruation especially in those who have not completed their family.

A two-year study of estrogen replacement therapy was conducted on 1,200 postmenopausal women. Computerized data concerning the effect on 20 common symptoms showed 95 per cent relief during an appropriate regimen of estrogen-progesterone therapy. The improvement in the ability to enjoy life counteracted any reluctance to undergo hormone-induced withdrawal bleeding in the women with an intact uterus. There was no laboratory or clinical evidence that the treatment caused cancer. The benefits of continuous cyclic hormone therapy for estrogen-deficient women far outweigh the possible dangers.

Summary: A trial was undertaken with 2 single-dose drugs for the inhibition of postpartum lactation. Two hundred patients were studied, of whom one half were given a single oral tablet of quinestrol (Estrovis) 4 mg. and the other half were given a single intramuscular injection of Ablacton. The results showed that both preparations were equally effective in the initial inhibition of lactation and were rarely associated with rebound breast engorgement or withdrawal bleeding.