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GYN: OTC OCFrom: art fougner, md (evsono@pipeline.com)Wed Jul 5 13:44:50 2000
from today's Reuters - Use of oral contraceptive slightly increases the risk of ischemic stroke WESTPORT, Jul 05 (Reuters Health) - The risk of ischemic stroke is increased with oral contraceptive use, even low-estrogen formulations, according to a report in the July 5th issue of The Journal of the American Medical Association. However, the researchers from the University of California, San Francisco, say the absolute increase is small since the risk is already low in this population. Dr. S. Claiborne Johnston and colleagues searched the literature for studies investigating the risk of oral contraceptives and stroke, from January 1960 through November 1999. From 804 studies identified, they collected data from 73 relevant studies and of these 16 were included in the meta-analysis. The investigators found that the relative risk for ischemic stroke with current OC use was 2.75. While the risk was reduced with lower-dose estrogen, the "risk was significantly elevated for all dosages." The relative risk fell from 4.53 with more than 50 micrograms to 2.08 with less than 50 micrograms of estrogen. Dr. Johnston's group writes, "The summary relative risk was 1.93 for low-estrogen preparations in population-based studies that controlled for smoking and hypertension." They also note that the relative risk of stroke was the same for women who had hypertension, smoked or had migraines. The team says that this "translates to an additional 4.1 ischemic strokes per 100,000 nonsmoking, normotensive women using low-estrogen oral contraceptives, or 1 additional ischemic stroke per year per 24,000 such women. " Because the risk is small with the smaller dosages of estrogen found in current oral contraceptives, the researchers say that "this additional risk appears to be outweighed by the health benefits of oral contraceptive use in improved birth control." JAMA 2000;284:72-78. the inevitable package insert will be drafted by legions of pharmaceutical attorneys. so my question is - will rendering oc's over the counter result in fewer or more pregnancies? art
-- art fougner, md
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