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Healthright. 1985 Aug; 4(4):9-12.The pattern of reproductive activity displayed by early hunter-gatherer ancestors, before the dawn of civilization, must have been vastly different from today's pattern. In the absence of contraception such women would have spent the greater part of their reproductive lives either pregnant or in lactational amenorrhea. In developing these ideas further it was estimated that a hunter-gatherer woman would have spent about 15 years in lactational amenorrhea, whereas just under 4 years would have been occupied by her 5 pregnancies, and she would only have had about 4 years of menstrual cycles. The total number of menstrual cycles she would experience in her entire life would be no more than about 50. This is in marked contrast to the situation today in a typical Western woman using contraceptives and experiencing menarche at 13 and the menopause at 50. Allowing her 2 years' respite from cycles during her 2 pregnancies, each followed by only a token period of breastfeeding, this leaves 35 years during which she would experience about 420 menstrual cycles. The conclusion is that an excessive number of menstrual cycles is an iatrogenic disorder of communities practicing any form of contraception. Thus, it is important to note that even the condom or vasectomy have important repercussions on the female's reproductive cycle. Since 99.9% of human existence has been spent living a nomadic hunter-gatherer life, this high frequency of menstrual cycles is a new experience, one that humans may be genetically ill-adapted to cope with. In fact, there are a number of "diseases of nulliparity" whose incidence is markedly increased in women with few or no children and who are therefore experiencing an increased number of menstrual cycles. These diseases include carcinoma of the breast, endometrium and ovaries, and endometriosis. As part of the effort to develop contraceptives that promote a healthy state of fertility, it is necessary to ask the question, "is a period really necessary?" To learn if women women accept a contraceptive method that reduced the frequency of menstruation, a clinical trial of an oral contraceptive was conducted. The OC was administered in such a way as to produce a withdrawal bleed only once every 3 months. This was termed the tricycle pill regimen. 196 women attending a family planning clinic in Edinburgh, Scotland, volunteered to participate, although 89 of them subsequently withdrew from the trial for a variety of reasons before it was completed at the end of a year. Overall, 82% of the women positvely welcomed the reduction in the number of periods; 91% of the women who completed the trial even refused to revert to a standard monthly OC regimen thereafter. The findings were in complete contrast to the results of a World Health Organization survey of patterns and perceptions of menstruation. But the WHO sample was highly biased in favor of women having regular menstrual cycles, and hence quite unrepresentative of the population as a whole. In sum, even the most pessimistic estimate of the WHO's menstruation survey shows that a proportion of women in every country investigated were prepared to accept amenorhea as a by-product of contraception. Reversible amenorrhea might become an increasingly popular form of contraception, and it might also confer significant health benefits.
Multinational comparative clinical trial of long-acting injectable contraceptives: norethisterone enanthate given in two dosage regimens and depot-medroxyprogesterone acetate. A preliminary report.
Contraception. 1982 Jan; 25(1):1-11.A multicenter phase 3 clinical trial compared norethisterone enanthate (NET-EN) given by 2 different treatment regimens and depot-medroxyprogesterone acetate (DMPA). After 18 months of observation, preliminary findings are reported for 790 women who received NET-EN 200 mg every 60 days; for 796 women who recieved NET-EN every 60 days (200 mg) for 6 months, then 200 mg every 84 days, and for 1589 women who received DMPA 150 mg every 90 days. Overall discontinuation rates and discontinuation for bleeding and personal reasons were similar for all 3 groups after 18 months observation (61.8-63.5/100 women). Terminations due to amenorrhea were significantly higher among DMPA users (12.1 and 17.4/100 women at 12 and 18 months) than among both NET-EN groups (6.8-8.2/100 women at 12 months and 10.4-10.9/100 women at 18 months). The only significant difference in pregnancy rates observed among the 3 groups was a higher rate at 18 months among NET-EN (84 days) users (1.6/100 women), than among DMPA users (0.2/100 women). There was no overall significant difference between the 2 NET-EN groups, although between the 6 and 18 month follow-ups when the 2 NET-EN regimens diverged, the NET-EN (84 days) users' pregnancy rates rose significantly, whereas in the NET-EN (60 days) group, the pregnancy rate did not change. Weight gain was significantly higher in those subjects using NET-EN at 60 day intervals than at 84-day intervals. (author's modified)
Multinational comparative clinical evaluation of two long-acting injectable contraceptive steroids: norethisterone oenanthate and medroxyprogesterone acetate: 2. bleeding patterns and side effects.
Contraception. 1978 May; 17(5):395-406.A WHO sponsored comparative trail (9 centers) studied the bleeding patterns and side effects experienced by 1678 women using injectable (every 12 weeks) norethisterone enanthate (NOR) and depot-medroxyprogesterone (DMPA). 388.8 women-years of menstrual experience with NOR and 372.5 with DMPA were studied. The percentage of women with total amenorrhea with DMPA was significantly higher than with NOR for all injection intervals. The porportion of women with total amenorrhea increased significantly over time with both drugs (chi-square=33.9 for NOR and 73.4 for DMPA; P < .001). After 1 year, 35% of DMPA and 8.6% of NOR users had total amenorrhea. With NOR, the cycle length distribution changed markedly over time, with the percentage of short cycles under 25 days diminishing as the percentage of long cycles in excess of 46 days increased. In contrast, DMPA held cycle length patterns more or less constant. Length of bleeding and spotting episodes were significantly greater with DMPA. The mean number of bleeding/spotting days decreased over time with both drugs; the difference from the 1st to 4th injection was statistically significant (P < .001). Though the overwhelming majority of women experienced abnormal cycles with both drugs, the percentage of normal cycles remained fairly constant during consecutive intervals. Headache was the most frequently reported complaint: 10.7% of DMPA and 6.9% of NOR users. Other nonmenstrual side effects were reported with similar frequencies in both groups.