WOMENS-HEALTH Messages for July, 1997: Re: OCPs and pre/perimenopause

Re: OCPs and pre/perimenopause

From: Laurie (anonymous@obgyn.net)
Wed, 9 Jul 1997 06:39:37 -0500 (CDT)

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At Tue, 8 Jul 1997, Patti wrote: My sisters and I are healthy, nonsmokers, reasonably physically >active, and
>don't currently have any risk factors for heart disease other than the
>family
>history.

>Are OCPs really safer than they used to be with respect to heart disease
>risk?

Most studies show no increased risk of heart attack in oral contraceptive users who don't also have other risk factors. Specifically, there is an increased risk in women who are hypertensive or who smoke.

Are some >formulations better
>than others with respect to heart disease risk?

It doesn't appear that way. There was a study published last year looking just at the newer, third generation progestin pills (like Desogen, OrthoCept, OrthyoCyclen) that showed no increased risk with those pills, either.

>
>What about OCPs that contain estrogen? How is it that OCPs are
>associated
>with heart disease but ERT is protective against heart disease? Is there
>any
>benefit to taking OCPs containing estrogen in the pre/perimenopausal
>years?

These studies were all done on combined oral contraceptives (containing estrogen + progestin). The doseage most commonly used for hormone replacement therapy contains a much lower amount of estrogen on an equivalency basis than the amount of estrogen contained in the Pill. The way I understand it, estrogen is thought to have some direct effects on increasing blood flow in the heart, but higher doses seem to "rev up" the clotting factors, and most heart attacks are caused by blood clots.

Benefits associated with OCP use include lower risk of ovarian cancer, lower risk of endometrial cancer, predictable cycles, and shorter, lighter, less crampy periods.

>
>Or, should we sign up all the brothers-in-law for the "spa weekend" at
>the
>vasectomy clinic? ;-)

I love the picture this brings to mind! Have you considered the IUD at all? Although the IUD got some bad press in the 70's, it's actually a very safe and effective method of reversible birth control in properly-selected individuals. The copper IUD available in the US is good for 10 years; this makes it very nice for the immediately premenopausal and perimenopausal woman who has it placed, then undergoes menopause before it has to be replaced. Most doctors' offices and family planning clinics have good brochures about the IUD for you to read, if you're interested.

>
>Thanks for any input.
>
>--
>Patti, Georgia (USA)

You're welcome. Wonder what the topic will be the next time you all get together....

--
Laurie Lovely, MD
RE fellow, UNC-Chapel Hill

Next message: Marie: "Re: Progesterone Supplements/Pregnancy Symptoms"
Previous message: Heather: "Re: Can estrogen be taken oraly to increase cervical fluids?"
In reply to: Patti: "OCPs and pre/perimenopause"
Next in thread: Kelly: "Re: OCPs and pre/perimenopause"

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