MORE PROS AND CONS FOR WOMEN TAKING HORMONES

o Risk of Ectopic Pregnancies is lower with Mini-Pills Containing lynoestrenol A previous study showed that the risk of ~topic pregnancy varied between different progestagens in low-dose progestagen contraceptives ('mini' pills)[l]. This study was followed by a 2-hospital survey from 1973-76 in Finland in which a total of 238 ectopic pregnancies were seen, of which 30 occurred in patients using mini pills. The risk of ectopic pregnancy was 1/1 170 women years with preparations containing Iynoestrenol 0.5mg, 1/250 women years with JevonorgestreJ (d-norgestreI) 0.03mg, and 1/ 2 90 women years with norethisterone O.3mg. Thus, lynoestrenol O. 5mg carried a significantly lower risk of ectopic

pregnancy than the other preparations.

'The superiority of Iynestrenol over other progestogens is obvious, and switching patients to this drug advisable. lynestrenol does, however, also carry a small risk of ectopic pregnancy, and it is therefore preferable to recommend combined hor­mone contraceptives if their side effects are acceptable.'

n Oestrogens Increase the Risk of Acute Myocardial Infarction in Women Under Forty-Six Two reports from the Boston Collaborative Drug Surveillance Program shown an increased risk of myocardial infarction (MI) in previously healthy women under 46 years of age taking oestrogens for contraception and other reasons. Of 107 women under 46

discharged from hospital after acute myocardial infarction, 26 were otherwise healthy and potentially childbearing [2]. 20 (77 %)

of these were taking OCs just before admission, and I was taking conjugated oestrogens. Among 59 control women, 14 (24 % )

were taking OCs and I was taking conjugated oestrogens. Comparison of OC users with non-users gives a relative risk estimate of 14 , with 90 % confidence limits of 5.5 and 37 . 24 of the 26 women were cigarette smokers. While myocardial infarction is rare in most healthy women under about 37 years of age, the risk in women older than this who smoke and take OCs seems to be high. From the same series of 107 women, 17 aged 39-45 years, who were otherwise apparently healthy, had had a natural menopause, hysterectomy, or tubal ligation or the spouse had had a vasectomy [3J. They were therefore not candidates for OC use. Nine(53 %) of them were taking non-contraceptive oestrogens just before admission. Four (12 %) of 34 control women were taking oestrogens. Comparing the 2 groups, the relative risk estimate is 7.5, with 90 % confidence limits of 2.4 and 24. 16 of the I 7 women with myocardial infarction were cigarette smokers.

'In view of present results and those reported for oral contraceptives, it appears prudent for women between the ages of 39 and 45 years to avoid any oestrogen use if they smoke or have conditions that predispose to MI, such as diabetes or hypertension. '

[IJ Liukko, P. etal.: Contraception 16: 575 (Dec 1977) . [2J lick, H. et al.: Journal of the American Medical Association 239: 1403 (3 Apr 1978)

, [3J lick, H. et aJ.: Ibid 239: 1407 (3 Apr 1978)

INPHARMA 29th ·April, 1978 .p6