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Reviews In Obstetrics and Gynecology. 2010 Spring; 3(2):55-65.Migraine affects as many as 37% of reproductive-age women in the United States. Hormonal contraception is the most frequently used form of birth control during the reproductive years, and given the significant proportion of reproductive-age women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population. In this review, key differences among headache, migraine, and migraine with aura, as well as strict diagnostic criteria, are described. The recommendations of the World Health Organization and the American College of Obstetricians and Gynecologists regarding hormonal contraception initiation and continuation in women with these diagnoses are emphasized. Finally, information about the effect of hormonal fluctuations on headache is provided with recommendations regarding contraception counseling in patients who experience headache while taking hormonal contraception.
[Research Triangle Park, North Carolina], FHI, .  p. (Research Briefs on Hormonal Contraception)A new Cochrane review conducted by Leiden University Medical Center in the Netherlands and Family Health International suggests that monophasic regimens should be the first choice over triphasic regimens for new oral contraceptive users.
World Health Organization Technical Report Series. 1981; (670):1-120.This report includes the collective views of a World Health Organization (WHO) Scientific Group on Research on the Menopause that met in Geneva during December 1980. It includes information on the following: 1) the endocrinology of the menopause and the postmenopausal period (changes in gonadotropins and estrogens immediately prior to the menopause and changes in gonadotropin and steroid hormone levels after the menopause); 2) the age distribution of the menopause (determining the age at menopause, factors influencing the age at menopause, and the range of ages at menopause and the definition of premature and delayed menopause); 3) sociocultural significance of the menopause in different settings; 4) symptoms associated with the menopause (vasomotor symptoms, psychological symptoms, disturbances of sexuality, and insomnia); 5) disorders resulting from, or possibly accelerated by, the menopause (osteoporosis, atherosclerotic cardiovascular disease, and arthritic disorders); 6) risks, with particular reference to neoplasia, of therapeutic estrogens and progestins given to peri- and postmenopausal women (endometrial cancer, breast cancer, and gallbladder disease); 7) fertility regulating methods for women approaching the menopause (fertility and the need for family planning in women approaching the menopause, problems of family planning in perimenopausal women, and considerations with regard to individual methods of family planning in women approaching the menopause); and 8) estrogen and the health care management of perimenopausal and postmenopausal women. At this time some controversy exists as to whether there is a menopausal syndrome of somatic and psychological symptoms and illness. There are virtually no data on the age distribution of the menopause and no information on its sociocultural significance in the developing countries. The subject of risks and benefits of estrogen therapy in peri- and postmenopausal women is of much importance in view of the large number of prescriptions issued for this medication in developed countries, which indicates their frequrnt use, and the different interpretations and opinions among epidemiologists and clinicians on both past and current studies on this subject. Specific recommendations made by the Scientific Group appear at the end of each section of the report. The following were among the general recommendations made: WHO sponsored research should be undertaken to determine the impact on health service needs of the rapidly increasing numbers of postmenopausal women in developing countries; uniform terminology should be adopted by health care workers with regard to the menopause; uniform endocrine standards should be developed which can be applied to the description of peri- and postmenopausal conditions and diseases; and descriptive epidemiological studies of the age at menopause should be performed in a variety of settings.
Geneva, Switzerland, WHO, 1981. 76 p. (WHO Technical Report Series No. 657)This report on the effect of female sex hormones on fetal health and development aimed to evaluate research on the specific types of sex hormones and their uses, to determine their safety with respect to fetal development and infant health, and to recommend further research in these areas. Theoretically, sex hormones can affect any stage of fetal development. Sex hormones appear to act by promoting synthesis of messenger ribonucleic acid (mRNA) in target tissues, so that research should focus on the specific proteins formed under the direction of newly synthesized mRNA to elucidate potential morphological and physiological effects of exogenous hormones. Following are some research avenues: cytogenetic research, microscopic and macroscopic examination, observations on births and later life, animal teratology, and epidemiological studies. Epidemiological studies not only help elucidate causal associations but also provide public health data. Studies of sex hormones and fetal development and infant health must be free of bias and often suffer from problems of defining pregnancy outcome. Also sex steroids are frequently administered at the same time as other drugs, leading to confounding effects of drug interactions. In order to assess existing data, it is necessary to disaggregate the data from different reports and then to regroup them according to the indications for use, i.e., infertility, contraception, pregnancy testing, supportive therapy during pregnancy, contraception during pregnancy, contraception during breast feeding. Likewise data must be disaggregated according to different types of exposure, i.e., preconception or postconception. The bulk of this monograph is spent disaggregating study data based on the above-stated rationales. The following recommendations are made for indications for use of sex hormones: 1) they should not be used as pregnancy tests; 2) diethylstilbestrol should not be prescribed to a suspected pregnant woman; 3) benefits of progestin therapies must first be proven before they can be recommended for use in supporting pregnancy; 4) oral contraceptives given before pregnancy seem to have no effect on subsequent pregnancy; and during lactation combined therapy should not be given.
Geneva, World Health Organization, 1964. (Technical Report Series No. 280.) 30 p.A WHO Scientific Group on the Biology of Human Reproduction was convened in Geneva from April 2-8, 1963, for the purpose of advising the Director-General on developments and major research needs in that field. The biology of human reproduction is an extremely broad scientific topic, which impinges to some degree on virtually all the basic medical disciplines. Major topics included in the report are: 1) comparative aspects of reproduction; 2) neuroendocrine aspects of reproduction; 3) biology of the gonads and gametes; 4) gestation; 5) biochemistry of the sex steroids; 6) immunological aspects of reproduction; and 7) pharmacological aspects of reproduction. The Group recommends: 1) that WHO assist in the development of fundamental knowledge of the biology of human reproduction and of other fields on which that knowledge is based and 2) that WHO convene meetings of appropriate specialist groups to consider practical methods of implementing certain proposals concerning organization of surveys, provision of services, and promotion of relevant research.
Bibliography on human reproduction, family planning and population dynamics: annotated articles and unpublished work in the South-East Asia Region: steroid contraception (including review of current status).
New Delhi, India, World Health Organization, Regional Office for South-East Asia, November 1974. (Special Supplement No. 1) 77 pThis annotated bibliography lists pamphlets, articles, and studies on combined contraceptives; low dose; injectables; long-acting; implants; postcoital; metabolic effects; lactation; long-term effects; biologic effects; metabolism; mode of action; contraception in the male; field studies; use in gynecological disorders; and works in progress on aspects of steroid contraception in centers in the South-East Asia Region. Sample titles are "Inhibition of ovulation for control of conception" and "Action of cyproterone acetate on male reproductive functions." A review of current status of steroid contraception includes a brief history; description of chemical composition; rates of effectiveness; side effects; clinical aspects; and return to fertility. Steroid releasing vaginal rings, IUDs, and intracervical devices are also described.
In: Sciarra, J.J., Markland, C. and Speidel, J.J., eds. Control of male fertility. (Proceedings of a Workshop on the Control of Male Fertility, San Francisco, June 19-21, 1974). Hagerstown, Maryland, Harper and Row, 1975. p. 274-307Literature on research approaches to permanent and relatively reversible methods of male fertility control is reviewed. Sources and expenditures for research into male fertility control are noted. Permanent methods discussed include electrocautery of the vas, transcutaneous interruption of the vas, vasectomy clips, chemical occlusion of the vas, and passive immunization. Reversible methods reviewed include vasovasotomy, intravasal plugs, and vas valves. Current research into animal models, reversibility after vas occlusion, nonocclusive surgical techniques, pharmacological alteration of male reproductive function, including adrenergic blocking agents, steroidal compounds, inhibitors of gonadotropin secretion, clomiphene citrate, organosiloxanes, prostaglandins, alpha-chlorohydrin, heterocyclic agents, and alkylating agents, and delivery systems for antifertility agents is discussed. Research into semen storage and improved condoms is also reviewed. As a relatively low proportion of funds are committed to research in male fertility control, a greater investment in applied and clinical research is warranted.