Advances in oral contraception. Questions and answers.

This paper is based on panel discussions presented at a conference on advances in oral contraception held in New York City on June 15 1982. The following statements were made: 1) the effects of estrogen differ geographically the incidence of jaundice in postmenopausal women on estrogen is much higher in Scandinavia than elsewhere; ethnic factors may be the cause and it is possible that diet and intestinal flora are involved; 2) the only area in which there is a definite link between oral contraceptives (OCs) and cardiovascular hazards is that of smoking and OC use by older women; 3) in rats ethinyl estradiol is 1.7-2 times as potent as mestranol in women ethinyl estradiol yields a sharper peak and a more rapid decline; 4) OCs with 30 mcg of estrogen act primarily by inhibiting ovulation not preventing implantation 5) breakthrough bleeding and hypomenorrhea are side effects of OC administration which might be handled by continuing the dose and seeing if the effects subside; 6) when amenorrhea is encountered as an OC side effect inadvertent pregnancy must be ruled out and the patient must be assured that she is not at risk; many times it is caused by a disease that developed earlier and surfaced when the patient was using OCs; 7) women using OCs who develop migraine headaches should be told to stop using them immediately; 8) tryptophan metabolism can be corrected if one uses vitamin B6 1 week/month; 9) women should stop taking OCs 6-8 weeks before elective surgery and before undergoing laparoscopic sterilization; 10) a woman who stops using OCs is not at risk of developing rebound clotting; 11) 1.5 mg of norethindrone acetate is exactly 10 times the dose of norgestrel; 12) studies have shown that when one discounts the immediate anovulatory effect of OCs after discontinuation the number of women who conceive is the same as that in a control population not using OCs; and 13) it is not necessary to wait 3 months after discontinuation of OCs before conceiving.