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    Estrogens: a generation of use.

    Pollner F

    American Pharmacy. 1981 Jun; 21(6):38-41.

    There are an estimated 8.4 million women today in the U.S. using combined OCs (oral contraceptives). The estrogen component of OCs can either be mestranol or ethinylestradiol. Formulations with high doses of estrogen are thought to be responsible for most of the side effects related to OCs, i.e. myocardial infarction, venous thrombosis, and thrombotic or hemorrhagic stroke. OC users are 3 times more likely than nonusers to have a fatal heart attack. In women who smoke or who are hypertensive, who have diabetes or high cholesterol levels, or who are in advanced age, the risk increases. High-dose estrogen formulations also seem to increase cholesterol and triglycerides levels, and suppress insulin after about 2 years of use. The use of ampicillin, rifampin or tetracycline may interfere with the contraceptive effect of the formulation. A recent longitudinal study conducted in Walnut Creek, California, concluded that OCs are safe for young, white, middle-class American women. It also noted an increased incidence among users of lung cancer, cervical cancer and malignant melanoma, and attributed these findings to higher rates of smoking, sexual activity, and sun exposure. There are not any postcoital drugs on the market today which are approved by the FDA. DES (diethylstilbestrol) is widely used as an antidote to unprotected intercourse; 25 mg are taken twice a day for 5 days, starting within 72 hours of coitus. The FDA has never been able to induce manufacturers to label the drug noting the severe side effects it can cause. High dosage ethinyl estradiol and conjugated estrogen are also used as postcoital contraceptives. ERT (estrogen replacement therapy) has been proven to increase risk of endometrial cancer, and it does alleviate vasomotor sequelae and vaginal atrophy and dryness. The value of ERT in retarding osteoporosis is still a controversial matter. The FDA and most gynecologists recommend prescribing the lowest dose of estrogen for the shortest time possible in patients for whom alleviation of postmenopausal symptoms by ERT seem warranted. The use of subcutaneous implant of estradiol pellets in the treatment of menopause-related vasomotor symptoms and for contraceptive purposes is currently being investigated.
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