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European Journal of Contraception and Reproductive Health Care. 1996 Dec; 1(4):299-300.Third-generation progestogens desogestrel, gestodene, and norgestimate were introduced in the late 1970s in a bid to reduce and refine the hormonal content of combined oral contraceptives. Pharmaceutical companies invested considerable resources into developing the products and research activities have been based, at least partly, upon advice from the medical profession regarding the relevant safety studies on risk of cardiovascular disease. However, in October 1995, and despite such efforts, the UK's Committee on Safety of Medicines (CSM) warned physicians and pharmacists about third generation oral contraceptives because the investigators involved in a World Health Organization cohort study had found an increased risk of deep venous thrombosis among users of such contraceptives containing desogestrel or gestodene compared with the second generation type of oral contraceptives. That finding was supported by unpublished data from the Transnational Study and the General Practice Research Data Base Study. However, even considering all of these data together, no definitive evidence has been presented of an increased risk of deep venous thrombosis in users of third generation oral contraceptives. Epidemiological flaws and biases could have been mainly responsible for the increases found in the incidence rates of deep venous thrombosis. Careful consideration should be given to the absolute risks of disease and the risk of unwanted pregnancies before a clinical alert is issued on oral contraceptive use.
INTERNATIONAL JOURNAL OF FERTILITY. 1989; 34 Suppl:14-7.Between 1945-1948, the population of Japan increased by 5 million people. Further, between 1947-1950, 2.7 million recorded births occurred each year resulting in the population growing from 72-83.2 million. The crude birth rate fell from a high of 34.3 in 1947 to a low of 11.1 in 1986. The population is expected to increase from 117-130 million (1090-2010) and then fall to and stabilize at 118 over 70 years. 80% of married women in Japan want to have 2-3 children. In 1984, 59% of married women used a family planning method and 83.1% ever used such a method. In 1979, the condom was the leading contraceptive among married couples (82%) followed by the rhythm method (23%). Since 1948 japanese women have been able to obtain a legal abortion. 600,000 induced abortions occur annually in Japan today. Even though the number of abortion have fallen steadily from 1955, the percentage of abortions among teenagers has increased from 1.6-4.7% between 1975-1985. Japanese would like to reverse this trend and the expected approval of oral contraceptives (OCs) could help do so. In 1979, only 3% of married couples depended on OCs. A concern of OCs many people worldwide held for many years was the cardiovascular risk of the high dose OCs. In Japan, however, the rate of thrombosis is lower than it is among Europeans and Americans. Thus Japanese women appear to be suitable candidates for Ocs, but, in 1986, 52% of married women had not formed an opinion on the pending approval of OCs. Further 43% said they would not use an OC. These results indicated a great need for OC education as well as for education on all contraception. Since 99% of all births occur under the guidance of skilled health workers, the health workers could inform women about contraceptives, but often are too busy to do so.