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Outlook. 1984 Dec; 2(4):4.Recent recommendations and statements issued by the US Food and Drug Administration (FDA), the Planned Parenthood Federation of America (PPFA), and the International Planned Parenthood Federation (IPPF) on the prescribing of oral contraceptives (OC) are briefly summarized. These statements reflect a growing concern about the effect of OCs on lipid metabalism. The FDA recommended prescribing OCs with the lowest effective dosage levels of progresterone and estrogen. According to the FDA's Fertility and Maternal Health Drugs Advisory Committee, OCs containing high doese of estrogens and progestins increse the risk of vascular disease. The National _medical Committee of PPFA recommede that the prescribing of high dosages of progestogens should be avoided whenever possible. The committee identified maximum dosage levels for progestogens. These maximum dosages were 1 mg for norethindrone, .5 mg for norethindrone acetate, 1 mbg for ethynodiol diacetate, .3 mg for norgestrel, and .15 mg for levonorgestrel. The committee noted that if progestogen levels are too low, breakthrough bleeding and contraceptive failure are more likely to occur. The International Medical Advisory Panel of IPPF recently issued a statement on lipid changes associated with progestogens. The panel noted that recent studies have shown that progestogens are associated with a decrease in high density lipoprotein cholesterol and an increse in low density lipoprotein cholesterol; however, the panel also noted that the subjects in the studies were given high doses of progestogens and that the studies were conducted in developed countries with high rates of obesity, alcohol consumption, and smoking.
Indian Journal of Medical Research. October 1978; 68(Suppl):80-87.Cross-sectional and longitudinal studies were made to assess vitamin nutritional status of women using oral contraceptives (OCs). In the cross-sectional study, data obtained on 20 women, who had used Ovulen 50 for 6-12 months, were compared with data obtained on matched controls who had never used OCs. In the longitudinal study, 23 women were examined initially (before OC use) and again at 1 or more points during the next 6 months of OC use. Changes were found in several parameters of nutrition tested. 1) OC use produced a highly significant rise in plasma vitamin A within 1 month of treatment. 2) Thiamine activity measurements showed a slight fall, but did not affect the TPP effect, suggesting that OCs did not seriously alter thiamine status. 3) Erythrocyte riboflavin concentration showed a fall, revealing a very high incidence (> 80%) of biochemical riboflavin deficiency in women before starting OCs which was further reduced after treatment. 4) There was a marked rise in urinary excretion of xanthuremic and kynurenic acids after a standard tryptophan load, indicating impaired tryptophan metabolism due to pyridoxine deficiency. 5) Erythrocyte folate levels showed a small but significant fall. These observations on Indian women belonging to low income groups show clearly that OC use does affect the vitamin economy of the body adversely. Biochemical evidence presented argues that OCs alter vitamin economy through rise in levels of some proteins which bind vitamins. Vitamin supplements are recommended not only for patient benefit but for program acceptability.