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Other opinions and further clarification please Re: Alesse's information incomplete?

From: K. (anonymous@obgyn.net)
Fri, 8 Sep 2000 14:00:05 -0500 (CDT)

((I would appreciate any other medical profession adding to this post or replying to my original question. Thank you!))

At Sat, 2 Sep 2000, William F. von Almen, II, MD, FACOG wrote: >
>At Sat, 2 Sep 2000, K. wrote:
>>
>>Recently, I was reading the insert to the birth control pill going by
>>the product name of "Alesse". In summary, it stated that the pill works
>>in two ways; 1) inhibiting ovulation, 2) thickening cervical mucus.

>K
>
>I think the primary ways the oc works are as stated.

Thank you for your response. Just to clarify what I think we are both stating, the primary mechanism of OC's is the inhibition of ovulation. The secondary mechanisms, as listed (for example) in the Physicians Desk Reference are 1) thickening of cervical mucus and 2) alteration of the endometrium to make implantation less likely.

>Because these will
>prevent pregnancy from occuring, it is pretty hard to >prove the third
>mechanism, which I was always taught, was theoretical, >only.

We know that inhibition of ovulation, ESPECIALLY with current "mini-pills", does not occur 100% of the time. In fact, based on a quick spate of research online, it seems that breakthrough ovulation can occur as high as 40% of the time. (A conservative estimate by some standards.) It is clear then, since the overall efficacy of OC's are still very high (over 99%), the two *secondary* mechanisms must in fact be working effectively.

Can you please, for my information, tell me where I could find reference to the third mechanism being "theoretical only". The PDR does NOT state that the secondary mechanisms are theoretical, and neither have any other documents pertaining to OC's that I have read. Indeed, it would seem that if these "back-up" mechanisms are theoretical, then we would have a much higher breakthrough pregnancy rate, since we know with "low-dose" pills there is a much higher incidence of ovulation, surely that is not disputed?

It concerns me again that manufacturers and physicians seem to have some motive for concealing this back-up mechanism, and as stated in my previous post, I find it insulting. It is also curious that there is such a disparity of information out there available, and a different spin on the medical facts (as provided to physicians directly) to the patients.

>Hope this
>helps.

I appreciate your reply, I would also appreciate further response as to the theoretical nature of the secondary mechanisms and a possible theory as to why the PDR treats those mechanisms as fact. I hope I am not getting too in-depth for the purposes of this forum, but I have a very inquisitive mind! :-)

Thanks again for your time and consideration,

Krista Cornish

>--
>William F. von Almen, II, MD, FACOG
>Editorial Advisor-Pregnancy and Birth
>Private Practice
>New Orleans, La.

--
K.Cornish



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