Robin Percival-Smith

Postcoital contraception with dl-norgestrel/ethinyl estradiol combination: Six years experience in a student medical clinic

Postcoital contraception with ethinyl estradiol/dl-norgestrel in combination has been available to women students attending the University of British Columbia since 1974. This paper reports on the side effects, cycle control and efficacy, for a six-year period (1979–1985). In this sample of women 50% reported side effects of nausea alone or nausea with vomiting. Length of the menstrual cycle was shortened in women who took the medication prior to the expected day of ovulation. The number of pregnancies reported was significantly (p<0.002) less than the number expected had the medication not been taken. Some women took the medication even though there was a possibility of conception earlier in the cycle and this might account for four of the failures. The mode of action of the postcoital medication remains unsolved making it difficult to understand possible reasons for the other 14 failures.

Vaginal colonization of escherichia coli and its relation to contraceptive methods

The prevalence rate of vaginal colonization with E. coli was studied prospectively among 495 healthy premenopausal women, and factors associated with vaginal carriage of E. coli were examined. Vaginal colonization with E. coli was found in 12% of women, and was significantly correlated with phase of the menstrual cycle (p less than 0.05), prior use of antibiotics (p less than 0.05), current genital complaints (p less than 0.05), history of previous urinary tract infection (p less than 0.001), and use of diaphragm or cervical cap for contraception (p less than 0.005). The high prevalence rate among diaphragm or cervical cap users remained significant when other confounding factors were kept constant (p less than 0.05). This observation may explain the association of diaphragm use and urinary tract infection demonstrated in previous epidemiologic studies and confirmed in the present study (p less than 0.05).

Cycle control on low-dose oral contraceptives: A comparative trial

Cycle control was studied comparing the monophasic oral contraceptive Loestrin with three low-dose phasic preparations (Triphasil, Ortho 10/11 and Ortho 7/7/7) in 391 women of whom 300 completed 6 cycles. Loestrin subjects had a rate of occurrence (31% of cycles) for intermenstrual bleeding (IMB) comparable to the rates for subjects on the phasic preparations (36%, 37% and 37%, respectively). Triphasil subjects had lower rates than the Ortho 10/11 and Ortho 7/7/7 subjects (p less than 0.01) in cycle one when all subjects were analyzed and in pre-study users when continuing menstrual flow (CMF) episodes were not included as IMB. IMB was a cause for dropping out of the study in 7% of subjects who were evenly distributed between groups. There were no differences between groups for BTB when perceived by subjects as a side effect. Spotting was perceived as a side effect more often with Ortho 10/11 and Ortho 7/7/7 use than with Triphasil (p less than 0.01). Loestrin, Ortho 10/11 and Ortho 7/7/7 subjects were more likely to report amenorrhea (p less than 0.001) and less likely to report leg cramps (p less than 0.01) compared to those on Triphasil. Triphasil subjects were less likely to report acne than subjects on Ortho 7/7/7 (p less than 0.01).

The effect of triphasic and biphasic oral contraceptive preparations on HDL-cholesterol and LDL-cholesterol in young women

Lipid changes were measured during two consecutive studies on efficacy, side effects, and metabolic changes of oral contraceptive (OC) preparations. The mean lipid values of women on OCs at the start of the two studies were compared to those of women who had not taken OCs for at least 3 months. It was found that LDL-cholesterol (LDL-C) mean values of the women on OCs were higher than the mean values of women who had not taken OCs for at least 3 months. In study #1, women received the OC preparation Triphasil. In study #2, women were randomised to one of 3 OC preparations (Triphasil, Ortho 777 or Ortho 10/11). HDL-cholesterol (HDL-C) and LDL-C were measured over time at six months and at 12 months after receiving the study medications. The results show that HDL-C increased in women on Ortho 777 and 10/11 and decreased in women on Triphasil at six months, and these changes were not found at 12 months. The results showed change over time for the LDL-C mean values, in that women not on OCs at the start of the studies had increased LDL-C mean values, and women on OCs at the start of the studies had decreased LDL-C mean values. Further the LDL-C mean values in women not on OCs at the start of the studies who received Triphasil (containing the gonane progestin dl-norgestrel) increased over time, whereas the combined mean values of those who received Ortho 777 and Ortho 10/11 (containing the estrane progestin norethindrone) did not increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Vaginal colonization with Escherichia coli in healthy women: Determination of relative risks by quantitative culture and multivariate statistical analysis

The rate of vaginal colonization with Escherichia coli in 495 healthy women was 12% in a prospective study with use of selective media and semiquantitative culture techniques. Computer-assisted multivariate analysis revealed that vaginal E. coli was significantly associated with the menstrual phase of the cycle, prior use of antibiotics, use of diaphragm or cervical cap for contraception, history of previous urinary tract infection, and coisolation of Staphylococcus aureus that was positive for the toxic shock syndrome toxin-1 (p less than 0.05, multiple stepwise logistic regression analysis). No significant association was observed with tampon use or brand, other contraceptive methods, sexual activity, genital symptoms, recent vaginal infection, or other personal habits. Quantitative cultures obtained sequentially throughout the menstrual cycle in 12 unselected women confirmed higher E. coli counts in menstrual or midcycle samples compared to paired premenstrual specimens (p less than 0.05, Wilcoxon paired rank sign test). These data emphasize the hormonal and other host determinants in vaginal colonization by E. coli and may explain the high rate of vaginal E. coli (64%), in addition to toxicogenic S. aureus, in acute toxic shock syndrome and the higher incidence of urinary tract infection in women with diaphragm or cervical cap for contraception compared to other contraceptive methods.

Lipid and lipoprotein changes during the seven days off oral contraception in women using two triphasic preparations.

This study was designed to determine whether mean values for lipids and lipoproteins changed during the 21 days on oral contraceptive (OC) preparations and during the seven days off the pills. The design allowed for comparison of the effects of Triphasil and Ortho 777 and for examining the consistency over two pill cycles. The mean values for total cholesterol, HDL-cholesterol, LDL-cholesterol and HDL3-subfraction were consistently lower on Day 20 when compared to Day 2 (p less than 0.05) for the two cycles and higher on Day 2 of Cycle II when compared to Day 20 of Cycle I. This fall-rise-fall pattern was consistent for cholesterol in 17 out of 28 of the women studied and these women were heavier (p less than 0.05), had a greater mean Quetelet Index (p less than 0.05) and had been using OCs for a shorter mean period of time (p less than 0.05). Consistently higher apolipoprotein A1 mean values were found on Day 20 of both cycles for Triphasil users compared to Ortho 777 users (p less than 0.02). This paper discusses the importance of these findings in relation to study design when measuring for differences between OC preparations and changes over time.

Postooital contraception: Some characteristics of women who use this method

This paper describes some of the characteristics of the women who attended a medical clinic requesting postcoital contraception. The information is derived from 871 observations in 653 women who requested this contraception. The mean age of women at the time of first request for this method was older than expected (21.9 years) and the mean time from first coitus to first request for the method was longer than expected (2.7 years). Previous pregnancy with therapeutic abortion was reported by 11.3% of the women. Multiple users of the method were younger at their first visit, and more likely to report a previous pregnancy. The method of contraception used before and after the need for postcoital contraception tended to be the same. Barrier method users have need of this method either for use when they fail to use their barrier method or for use when their barrier method fails. The need for more general availability of this method is discussed.

Vaginal Colonization with Staphylococcus aureus, Positive for Toxic-Shock Marker Protein, and Escherichia coli in Healthy Women

The vaginal colonization of 495 healthy women with strains of Staphylococcus aureus positive for the toxic-shock marker protein (pyrogenic exotoxic C) was examined prospectively. Production of the marker protein was detected by analytic isoelectrofocusing of culture filtrates in polyacrylamide gels (isoelectric point, 7.2). Toxicogenic strains of S. aureus were isolated from 2.6% of the women and nontoxicogenic strains from 4.0%. Vaginal carriage of toxicogenic S. aureus was found to be significantly correlated only with coisolation of Escherichia coli when a number of factors were analyzed by multivariate logistic regression and compared with values among women carrying no vaginal S. aureus or only nontoxicogenic strains (odds ratios, 8.17 and 11.02, respectively; 95% confidence intervals, 2.27-29.31 and 1.42-85.31, respectively). These data may explain the higher rate of vaginal colonization with E. coli in addition to toxicogenic S. aureus among women with toxic-shock syndrome (64%) than among age-matched control women (12%; P less than .001).