• released in 1960’s without adequate testing by FDA

• doctors prescribed drug, even though medical literature warned of dangers

• dangers included blood clots, heart attacks, strokes, depression, suicide, weight gain, decreased sex drive

• high doses of estrogen were the problem

• now low-dose combination drug is safer and may have some health benefits

• 70 million women world wide

• most popular reversible method in U.S.

• third-generation pills (different type of progestin) may cause non-fatal blood clots, so are not recommended

• inhibits the development of the egg in the ovary

• low levels of estrogen normally ® hypothalamus (GnRH) ® pituitary (FSH) ® development of follicle and egg

• the pill keeps synthetic estrogen levels (estradiol) high enough to prevent the feedback to the hypothalamus \ keeps the ovaries relatively inactive

• same principle during pregnancy; placenta ® corpus luteum produce estrogen and inhibit FSH

• if levels of estrogen are too low for your body or you miss a pill, may still ovulate

• progestin (synthetic progesterone) also has contraceptive effects:

• ­ thickness of cervical fluid

• slowed movement of sperm

• slowed movement of egg

• incomplete development of endometrium

• monophasic, biphasic, triphasic or progestin-only pills available

• monophasic: constant low doses of estrogen and progestin (30m g of estrogen in all, but different types and amounts of progestin)

• third-generation pills (Desogen or Ortho-Cept) contain a new type of progestin called desogestrel

• Bisphasic: less progestin during first ten days, more during second ten days, but estrogen stays constant through out cycle (not often used)

• Trisphasic: each third of cycle, amount of progestin or both varies. Progestin increase each third, estrogen increases mid-cycle. Offers low dose of estrogen and lower dose of progestin then other types of pill

• Progestin-only pills are a new solution for those not wishing to take estrogen, provide contraception through the effects of progestin listed above
• Must take every day

• causes very irregular menstrual periods and spotting

• may cause breast tenderness

• ­ risk of ectopic pregnancy and ovarian cysts

Combination pills:

• how effective are they?
• Expected pregnancy rate of 0.1%, but failure rate of 5%

• when do they fail?

• First seven days of use

• Missed pill (especially at beginning or end of 21 day cycle)

• Two or more pills missed during cycle

• Antibiotic use (rifampicin, but also others depending on women)

• Anticonvulsants

• Severe vomiting or diarrhea

Reversibility:

• most women soon become fertile again, but may take 2 months longer than usual

How long can you take it?

• indefinitely without problems occurring

• we are a part of the long term experiment on the effects of daily hormone use

• > 40 years of age, increased risks

• should you take breaks from the pill? Recent literature says no

• many women that change methods become pregnant in the first few months

When problems occur:

• problems lasting 2 or more cycles

• pain or swelling in the legs

• extreme headache, dizziness or weakness

• numbness, blurred vision, speech problems

• chest pain, cough, shortness of breath, abdominal pain

• may be signs of heart attack, stroke, or liver tumors

Contraindications:

• any disease which involves excess clotting

• stroke, heart disease or defects

• hepatitis or liver diseases

• heavy smokers

• breast feeding and < than six months after birth

• breast cancer (or history of) or reproductive cancers, pregnancy, hypertension, or more than 20 years of pill use

The pill and Cancer:

• some studies have shown relationship between cervical cancer and the pill, therefore requiring a Pap smear every year

• controversy with breast cancer, most say not a risk, but recent studies indicated ­ risk if began the pill before age 25, and used for more than 4 years, to develop breast cancer before the age of 35

• ¯ risk of endometrial and ovarian cancer for ten years after they stop taking it

The Pill and Exercise:

• exercise appears to offset any net changes in coagulation due to use of the pill

• same effect seen on cholesterol levels

• ­ menorrhagia (heavy), and dysmenorrhea

• Cause a chronic low grade infection or inflammation in the uterus. Body produces higher number of prostaglandins and enzymes in uterus and fallopian tubes to combat, which damage or destroy sperm

• ­ chances of pelvic inflammatory disease, can become embedded or perforate the uterus wall, ­ ectopic pregnancy

Mechanical Barrier Methods:

• diaphragm, 20% failure rate due to movement of diaphragm

• must remain in place 6-8 hours after intercourse, and may cause discomfort during exercise

• sponge or condom are other choices

Norplant

• subdermal implant system which release levonorgestrel (synthetic progestin) from 6 capsules, causing suppression of ovulation

• lasts for 5 years

• side effects: irregular bleeding, headaches

• no idea has this may affect athletic performance

• depot-medroxyprogesterone acetate administered as a intramuscular injection of 150 mg every 3 months

• 30 million women world wide

• prevents ovulation

• does not interact with antibiotics, unlike the pill or Norplant

• ¯ the risk of seizures in women with seizure disorders

• causes bone loss especially in girls under the age of 16

• endometrial tissue outside of the uterus

• can be located on the ovaries, fallopian tubes, bladder, intestines, peritoneum or ligaments

• can be referred to as growths, nodules, tumors, or lesions

• tissue responds to hormones of menstrual cycle and build up, break down and produce bleeding

• causes internal bleeding, inflammation and cysts and scar tissue are the result

• immune system appears to involved, but mechanism not fully understood, may be caused by "back up" of tissue out of the fallopian tubes, or may be genetically based

• treatment with danazol (testosterone derivative) may increase athletic performance due to ¯ fat and ­ muscle, but many other side effects

• GnRF analog as treatment may also cause bone loss

• studies are conflicting concerning the effects of menstrual cycle and performance

• some women perform better or perceive they perform better in follicular phase and may want to manipulate menstrual cycle

• take contraceptive pills for a few months before event, stopping 10 days before event

should have low levels of both hormone during event.

Fertility:

• fertility may be ¯ if the athlete is amenorrheic, has luteal phase deficiency, or oligomenorrheic

- may need to decrease intensity of training if pregnancy is desired