Tag: morning-after pill

DES still “recommended” in 1982…

Abstract

Adolescent care needs to include specific questions regarding the patient’s sexual development. The clinician who wants to address the contraceptive needs of his/her teenage patients must be familiar with the various psycho-medico-legal components of this issue. Male and female coitally active youth need to be taught responsible sexual activity. A thorough and honest discussion about sexuality and contraception should be held with youths who state they want to become, or are and will continue to be, sexually active. Contraception during adolescence is a complex and frequently emotionally charged issue. Contraceptive choice is dependent upon many factors, including the patient’s cognitive development, his/her specific choice to use or not to use contraception, the patient’s knowledge of specific methods, results of medical screening, the patient’s specific sexual activity, moral and religious attitudes, the clinician’s professional views about adolescent sexuality, and contraception.

The following specific contraceptive methods are reviewed in terms of their use by youth: abstinence, barrier methods, oral contraceptives (OCs), IUDs, postcoital contraception, and injectable contraceptives. Many youths are not sexually active and abstinence can always be suggested to individuals who have already been sexually active. Many teenagers choose to be and to remain coitally active, and realistic discussions with patients are essential.

In general the 1st choice of a contraceptive for sexually active youth should be some type of barrier method. The advantages and the disadvantages of the diaphragm, the condom, and vaginal contraceptives should be reviewed with specific application to the adolescent population. OCs continue to be the most popular of the effective contraceptives. Particularly with OCs there is a need for a careful medical history and physical examination with pelvic examination. It is this physician’s opinion that patients should be on OCs only until they will accept safer methods such as barrier contraceptives. The copper T or Copper 7 IUDs are very effective contraceptive methods which can be considered for carefully screened teenagers. Diethylstilbestrol has been recommended in emergency situations such as rape. Other postcoital agents which also work are ethinyl estradiol, conjugated estrogens, progestogens, and postcoital IUD insertion. Injectable contraceptives can be selected in certain situations were OCs cannot be used.

Sources

• Contraception in adolescence, Delaware medical journal, NCBI PubMed, PMID: 7128877, 1982 Jul.
• Image credit Jason Leung.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES used as an emergency contraception, The Netherlands, 1981

Abstract

Some form of postcoital contraception for protection against unwanted pregnancy is indispensable today especially in cases of rape, failed mechanical contraception, or 1st sexual contact without contraception.

A tablet form of postcoital contraceptive would be acceptable if 100% certainty is assured and it doesn’t involve adverse effects.

Postcoitally administered high-dose estrogens proved effective in Macaca mulatta.

Diethylstilbestrol in variable dosages with or without ethinylestradiol was used in various studies and with variable results.

Pregnancy rates depended on time of coitus in cycle, contraceptive dosage, and time of administration after coitus (within 72 hours).

Conjugated estrogens and various progestagens or combinations of both have been tried with variable success.

Another form of postcoital contraception is IUD insertion within 7 days following unprotected coitus. Advantages of this method are the time factors and absence of adverse effects of hormonal contraceptives.

Postcoital hormonal contraceptives cause changes in the endometrium which prevent blastocyst implantation. They alter tubal function affecting zygote movement towards the uterus. They have an antiovulatory effect and may be luteolytic. Estrogens have more severe side effects than progestagens.

Nausea, vomiting, mastodynia, fluid retention, and vaginal bleeding can result from estrogens. Progestagens can cause irregular bleeding. Combination of both can cause menstrual irregularity.

Postcoital hormonal contraceptives are contraindicated in heart and liver diseases, thrombosis, and pregnancy (teratogenic and carcinogenic effects on offspring).

Pregnancy despite postcoital contraception results in extrauterine pregnancy in 10% of patients. The most important reservations in evaluating publications on this subject are:

1. lack of control group;
2. estimation of pregnancy probability is not reliable because of study population used;
3. patient fertility cannot be ascertained;
4. and reliability of information provided by patient.

Conclusion from literature studies is that postcoital hormonal contraception is of value but effectiveness is not proven. More research is needed and indications are that other less radical drugs may be found in near future.

Sources

• Postcoital contraception, Nederlands tijdschrift voor geneeskunde, NCBI PubMed, PMID: 7254397, 1981 Jul 11.
• Image credit Helen Keen.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES prescribed despite known teratogenic and potentially carcinogenic effects

1981 Study Abstract

The contraceptive effect of large doses of estrogens administered postcoitally is not fully understood, although numerous reports have described the use of a 4 to 6 day course of high dose oral diethylstilbestrol (DES), ethinyl estradiol, conjugated estrogens, and combinations of estrogen and progestogen.

Because estrogens are effective postovulatory rather than postcoital contraceptives, it is necessary to know the exact time of unprotected intercouse in relation to a woman’s menstrual cycle. Depending on the frequency and timing of intercouse, a 5-day course of postcoital estrogen, introduced within 72 hours, yields a pregancy rate of .03-.3%. Failures are usually due to inadequate doses of estrogen, errors in timing, or multiple exposures.

A lowering of basal body temperature after postovulatory administration of high doses of estrogen indicates successful intervention. Existence of various conditions such as hypertension and migraine contraindicate the use of postcoital estrogens. DES and possibly other estrogens are associated with teratogenic and potentially carcinogenic effects. 70 to 80% of women taking postcoital estrogens report side effects such as nausea, weight gain and headache.

No randomized studies have compared the efficacy, side effects, or safety of the available estrogens. The use of informed coinsent procedures is advised because of the potency of high dose estrogens.

Sources

• Estrogens and postcoital contraception, Female patient, NCBI PubMed, PMID: 12278953, 1981 Jul.
• Image credit your-life.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

Contraceptive technology, 1980

Abstract

Studies by A. Albert Yuzpe, MD, and Lee H. Schilling, MD, have shown Ovral to be an effective contraceptive after unprotected intercourse at any time in the menstrual cycle, not just in midcycle.

As a morning after pill, Ovral is taken in 2 doses: 2 tablets within 72 hours after coitus; 2 tablets 12 hours later, a total of 200 mcg ethinyl estradiol and 2 mg di-norgestrel. Risk of pregnancy from a single act of unprotected midcycle coitus averages 20-30% while the risk from unprotected intercourse at other times in the cycle averages 2-4%. Young, nulliparoous, women would be the prime target for the morning after pill. 98.5% of the women in Yuzpe’s study bled within 21 days. The 1.5% who do not bleed within the expected time will either be pregnant or have a delayed period. Ovral can be administered from a pack in the doctor’s office.

The major complaint about DES was nausea and vomiting. Only 24% of the women taking Ovral reported nausea. The episodes were mild and controlled with an antiemetic.

Both doctors and patients are wary of DES because of public concern about teratogenesis. Many doctors recommend termination of pregnancy if it was conceived while the woman was using DES. Ovral use does not usually indicate abortion.

The postcoital IUD insertion studies have included small numbers of patients, but the difficulties are that bleeding following insertion may suggest pregnancy, and the potential for pelvic infection is increased. Ovral should not be given to women who have contraindications to oral contraceptives, and benefits and risks should be weighed.

Sources

• Ovral touted as morning-after pill, NCBI PubMed, PMID: 12261790, 1980.
• Image credit worldnewsblog.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES used as an emergency contraception, Hungary, 1978

Abstract

It is almost impossible at this point to make an estimate of the possible delayed adverse effects of the hormonal contraceptives presently marketed. The consequences of the administration of DES were revealed years later as it affected the children of the women who had been taking it.

The author discusses the word “catastrophy” in connection with this kind of consequences. He asks the question whether the mortality due to illegal abortion and even to legal abortion in the 1st years following its legalization should not also be considered as a catastrophy. The author refers in his argument to a paper published in the journal Orvosi Hetilap by Professor Csaba in 1977.

Another question doctors ask themselves concerns the relativity of a side-effect’s seriousness. Should one consider the damage done to the individual, or the number of subjects affected? There is no doubt that the presently used hormonal contraceptives contain a number of possible side effects, which however may be kept under control to a certain extent by doctors who carefully respect their indications and contraindications before prescribing them. But it is at this point extremely difficult to predict which delayed effects they might have. The medical schools in Hungary are doing a lot of research on the subject, but what can be done about the women who have been taking oral contraceptives for 10 years already? The possible delayed effects have not even started to show in these patients.

The author underlines the fact that medical schools should insist more than they do on the ethical aspects of medicine.

Sources

• Delayed adverse effects of contraceptives, NCBI PubMed, PMID: 652347, 1978 May.
• Image credit creativemornings..

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES used as an emergency contraception, Czechoslovakia, 1977

Abstract

55 women were administered a series of postcoital contraceptives, 35 of whom received only a single application and 20 received the preparations for more than 1 cycle (more than 2 but less than 13).

34 women of the 1st group (48 hours after unprotected coitus) and 7 women from the 2nd group were administered diethylstilbestrol (DES) for 5 days for a total of 250 mg.

The remaining subjects were given norethisterone Spofa for 3 days at 30 mg/day.

Results from this administration in the sense of a general contraceptive were not considered favorable, primarily due to contraindications in regard to physiological side effects, particularly with DES. DES proved to be the most successful in preventing pregnancy.

Sources

• Postcoital contraceptives in clinical practice, NCBI PubMed, PMID: 321139, 1977 Feb.
• Image credit proclinical.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES also used as an emergency contraceptive in The United Kingdom, 1973

Summary

Oestrogens as postcoital contraception have been prescribed for 282 women at the Brook Advisory Centre (Avon) since January 1973.

A daily dose of 50 mg diethylstilboestrol for 5 days started within 72 hr of unprotected intercourse was used from January 1973. This was changed to 5 mg ethinyl oestradiol in May 1974.

There were no pregnancies nor any serious side effects. Follow-up showed that most women had their next period at the expected time.

Sources

• The Use of Oestrogens for Postcoital Contraception, cambridge, doi.org/10.1017/S0021932000000481, January 1977.
• Image credit Louise Naimian.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.

DES used as an emergency contraception, Czechoslovakia, 1976

Abstract

37 women, 18-45 years old, were administered diethylstilbestrol (DES), 20 mg 3 times daily over the course of 5 days 24-48 hours after unprotected intercourse during the estimated time of ovulation.

Pregnancy was registered in only 1 case.

The effects of DES on the levels of follicle stimulating hormone, luteinizing hormone (LH), and progesterone were determined in 7 of these women during the entire course of a cycle.

• A decrease in the level of LH was the only abberation found in comparison with a normal control group.
• Ovulation was not suppressed by the application of DES.
• Progesterone values in the luteal phase were normal for 4 women, while 3 showed a more rapid decrease in this level, which preceded menstruation by 3-5 days.
• It was observed that after the administration of DES luteolysis did not occur in the ovulatory phase, although the ovulatory mechanism was disrupted.

Sources

• Our experience with “morning-after-pill” (author’s transl), NCBI PubMed, PMID: 975286, 1976 Aug.
• Image credit bob milton.

DES DIETHYLSTILBESTROL RESOURCES

• Source DES and pregnancy studies.
• Diethylstilbestrol DES studies listed by topics and date of publication.