WOMENS-HEALTH Messages for September, 2000: Re: Other opinions and further clarification please Re: Alesse's information incomplete?

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

From: D. Ashley Hill, MD (anonymous@obgyn.net)
Fri, 8 Sep 2000 16:01:45 -0500 (CDT)

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In reply to: K.: "Other opinions and further clarification please Re: Alesse's information incomplete?"

At Fri, 8 Sep 2000, K. wrote:

>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.

I suspect you are using the terms "mini pill" and "low dose pill" to mean the same thing, which they are not. Mini pills are progesterone-only pills (a common brand is Micronor), whereas low dose pills refer to almost all of the combined pills, meaning they contain estrogen and progesterone. The term low dose arose years ago when the dosage of estrogen dropped to the current 20, 30, and 35 microgram levels.

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?

See above. The incidence of ovulation with minipills is less than low dose pills, but low dose pills probably have a very low incidence of ovulation.

>It concerns me again that manufacturers and physicians seem to have some
>motive for concealing this back-up mechanism

What a curious, misplaced statement. Why would doctors conceal a particular mechanism for pregnancy prevention? Remember, ob/gyn doctors stand to make a lot more money delivering a baby than prescribing a pill. Where is the motivation for "hiding" the mechanism for a particular medical treatment? If a patient requests contraception and, after hearing the plusses and minuses about each product, chooses one over the other, it makes no difference to me. It's her choice.

It is also curious that there is >such a disparity of information out there available

Similar to Dr. von Almen's statement, I also was never taught that endometrial thinning was a major factor for low-dose oral contraceptive efficacy. I graduated from a "top-ten" residency program, so I am confident that I received a fine education regarding contraceptives. Endometrial thinning probably contributes much more to progesterone-only contraception efficacy (mini-pills, Norplant, depo-provera). I'm visiting family, but when I get back will look through my references.

--
David Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
http://home.cfl.rr.com/dahmd

My apologies, but due to time constraints I am unable to answer private e-mails.

Next message: Harvey S. Marchbein, M.D.: "Re: uterine artery embolization"
Previous message: Ali: "uterine artery embolization"
In reply to: K.: "Other opinions and further clarification please Re: Alesse's information incomplete?"

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