CliffordR. Kay

ORAL CONTRACEPTIVES AND VENOUS THROMBOSIS

Data is presented on the risk of venous thrombosis due to oral contraceptive use. The estimated risks are based on the observation of 32850 women-years of pill users 11763 women-years of exusers and 41170 women-years of controls. Women having or developing a medical condition predisposing to venous thrombosis were excluded. Periods of pregnancy also were excluded from observation as well as recuperative periods for women undergoing surgery. Observations were simultaneously standardized for age parity cigarette smoking and social class. The estimated risks for pill users are 117 per 100000 per year for superficial thrombosis and 81 per 100000 for deep thrombosis. This is 2.63 times the risk for controls for superficial and 5.63 times the risk for controls for deep-vein thrombosis (both p less than .01).

Oral contraceptives allergy pregnancy and depression.

A letter discussing allergy pregnancy and depression in oral contraceptive users is presented. A possible relationship of oral contraception to nasal catarrh hay fever and allergic rhinitis has been covered in a report by the Royal College of General Practitioners on oral contraceptives and health. Convincing evidence of a relationship of oral contraception to atopic eczema and eczema due to external agents photosensitivity neurodermatitis and the nonspecific erythemas has been advanced. Experience in 96 women who conceived accidentally while they were still using the pill provides no evidence that the pregnancies were in any way affected by the continued ingestion of oral contraceptives during the early weeks after conception. The report concluded that depression is probably an uncommon result of pill usage. It wasnoted that in any group of oral contraceptive users who become depressed the pill can be considered the cause of their depression less than 25% of the women. Dr. Adams has determined that 25% of depressed pill users responded to a pyridoxine treatment. It is possible that the findings of Dr. Adams can provide the basis of management of depressed pill users which avoids the arbitrary discontinuation of the pill.

Points: Oral contraceptives and otosclerosis

erythematous nodules and plaques and a skin biopsy examination and slit skin smear examination subsequently established the diagnosis of lepromatous leprosy. The skin lesions were of erythema nodosum leprosum, which had been suppressed by prednisolone throughout these years. Remarkably, there was little other clinical evidence of the infection. Dr Prendivilles lesson is timely. Although its message has been known for 30 years to all leprologists, physicians and surgeons need to be reminded of it regularly.

THE R.C.G.P. ORAL CONTRACEPTION STUDY

The latest report from the Royal College of General Practitioners Oral Contraceptive Study supersedes their 1977 paper and handles the intermittent pill users differently. The report concentrates on deaths from circulatory disorders and their relation to oral contraceptive (OC) use and to age and smoking habits. The yearly drop-out rate is said to average 6.4% in the ever-users and 6.6% in the controls. This represents a 54% loss to follow-up. Were the drop-out rates the same for the women who were new OC users when enrolled into the study? The RCGP study gives a relative risk of 1.5 for deaths due to accidents and violence, the numbers of such deaths being 34 in the ever users and 17 in the controls. Vessey et al. found admission rates for self-poisoning (per 1000 woman years) to be 0.83 for OC users, 0.21 for diaphragm users, and 0.40 for women fitted with an IUD. This sample was aged 25-39, thus excluding younger women who are more likely to take overdoses. The mental effects of OC use are too important to be ignored. For cancer deaths the relative risk was 1.0. There were 19 deaths due to breast cancer in the ever-users and 10 in the controls.