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Contraception 65 (2002) 447– 448
Letters to editor
To the Editor: I read with interest the report by M.A. Khan concerning the side effects and oral contraceptive pill (OCP) discontinuation rate in rural Bangladesh [1]. I found the high incidence of dizziness (57.4%), weakness (28.6%), and vomiting (23.4%) of great interest, especially when compared to the low incidence of excessive (3.1%) and irregular (1.7%) menstruation. These findings suggest that the steroidal content of the oral contraceptive pill or pills was too high for most of the women being treated. It is not possible to tell whether the progestin or the estrogen component was the cause of the fainting, weakness, and nausea, but both may be contributing factors [2]. A similar excessiveness of side effects was observed in a 1972 study of OCP discontinuation in Filipino women after a change from lower to a higher progestational and estrogenic activity OCP [3]. Bangladesh women, as most Asian women, are usually of much lower average weight than Western women, for whom most current OCPs have been designed. An association between excessive nausea and low incidence of breakthrough bleeding in low body weight women, and the opposite in overweight women, has also been reported by Talwar and Berger [4]. Although it would be helpful to know the relationship of particular side effects to body weight in Bangladesh women, this is often not possible to determine because scales are often not available, nor is body weight recorded, in rural clinics. However, it may be possible to determine if particular side effects were related to the pills’ steroidal content if more than one brand of pill was used. That information, if obtainable, and the previous reports cited might suggest that an OCP with lower steroidal content would be better tolerated by Bangladesh, and by inference other Asian women, with a corresponding reduction in discontinuation.
References [1] Khan MA. Side effects and oral contraceptive discontinuation in rural Bangladesh. Contraception 2001;64:161–7. [2] Dickey RP. Managing contraceptive pills patients. 10th ed. Dallas, TX: Essential Medical Information Systems, Inc., 2000.
[3] Dickey RP, Porter CW, Wells JP. Report of the survey team concerning the decrease in pill acceptors in the Philippines family planning program covering the period March 11-March 22, 1973, prepared under the auspices of the American Public Health Association in agreement with the U.S. Agency for International Development, 1973, p. 113, unpublished. [4] Talwar PP, Berger GS. Side effects of drugs: the relationship of body weight to side effects associated with oral contraceptives. Br Med J 1977;1:1637– 8.
Richard P. Dickey, M.D., Ph.D. Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology, Louisiana State University School of Medicine, New Orleans, New Orleans, LA 70128, USA Reply: letter to the editor夞 Sirs, Thank you for giving me the opportunity to respond to Professor Dickey’s letter, which raised some interesting points. As explained in the Materials and Methods section of the article [1], the study used data from a recent oral contraceptive (OC) compliance survey. The survey did not have the body weight information for the respondents; however, information about the pill brand used was available for the current OC users but not for the women who discontinued OC use. This limits the scope of addressing the issue of relationship between the pill’s steroidal content and the occurrence of side effects. Of the women who continued OC use (n ⫽ 801), about 63% were using high dose pills (50 g/day of ethinyl estradiol or mestranol), and about 37% were using low dose pills (30 –35 g/day of ethinyl estradiol or mestranol) [2]. However, at least one side effect was experienced by more than half of the OC users during the first three months of their OC use (459 of 801). An attempt was made to examine the association between the pill’s steroidal estrogen (such as ethinyl estradiol or mestranol) dose and the occurrence of side effects. The analysis revealed no evidence of relationship; however, dizziness and weakness were slightly more prevalent among the low dose pill users compared to their high dose pill users counterparts without statistical significance. Nevertheless, the survey was not designed to assess such an association and a clinical study of the relationship
0010-7824/02/$ – see front matter © 2002 Elsevier Science Inc. All rights reserved. PII: S 0 0 1 0 - 7 8 2 4 ( 0 2 ) 0 0 3 0 1 - 3
448
Letter to the Editor / Contraception 65 (2002) 000 – 000
of side effects to the pill’s steroidal contents will be a very interesting research topic. M. Azaduzzaman Khan School of Health, University of New England, Armidale, NSW 2351, Australia
References [1] Khan MA. Side effects and oral contraceptive discontinuation in rural Bangladesh. Contraception 2001;64:161–7. [2] Manual for birth control oral contraceptives, Norplant, and condom (In Bangali). Family Planning Clinical Services Project. Dkaha: Directorate of Family Planning, Government of the Peoples’ Republic of Bangladesh, September 1995. 夞 PII of original article S0010-7824(01)00302-5.
Letters to editor
To the Editor: I read with interest the report by M.A. Khan concerning the side effects and oral contraceptive pill (OCP) discontinuation rate in rural Bangladesh [1]. I found the high incidence of dizziness (57.4%), weakness (28.6%), and vomiting (23.4%) of great interest, especially when compared to the low incidence of excessive (3.1%) and irregular (1.7%) menstruation. These findings suggest that the steroidal content of the oral contraceptive pill or pills was too high for most of the women being treated. It is not possible to tell whether the progestin or the estrogen component was the cause of the fainting, weakness, and nausea, but both may be contributing factors [2]. A similar excessiveness of side effects was observed in a 1972 study of OCP discontinuation in Filipino women after a change from lower to a higher progestational and estrogenic activity OCP [3]. Bangladesh women, as most Asian women, are usually of much lower average weight than Western women, for whom most current OCPs have been designed. An association between excessive nausea and low incidence of breakthrough bleeding in low body weight women, and the opposite in overweight women, has also been reported by Talwar and Berger [4]. Although it would be helpful to know the relationship of particular side effects to body weight in Bangladesh women, this is often not possible to determine because scales are often not available, nor is body weight recorded, in rural clinics. However, it may be possible to determine if particular side effects were related to the pills’ steroidal content if more than one brand of pill was used. That information, if obtainable, and the previous reports cited might suggest that an OCP with lower steroidal content would be better tolerated by Bangladesh, and by inference other Asian women, with a corresponding reduction in discontinuation.
References [1] Khan MA. Side effects and oral contraceptive discontinuation in rural Bangladesh. Contraception 2001;64:161–7. [2] Dickey RP. Managing contraceptive pills patients. 10th ed. Dallas, TX: Essential Medical Information Systems, Inc., 2000.
[3] Dickey RP, Porter CW, Wells JP. Report of the survey team concerning the decrease in pill acceptors in the Philippines family planning program covering the period March 11-March 22, 1973, prepared under the auspices of the American Public Health Association in agreement with the U.S. Agency for International Development, 1973, p. 113, unpublished. [4] Talwar PP, Berger GS. Side effects of drugs: the relationship of body weight to side effects associated with oral contraceptives. Br Med J 1977;1:1637– 8.
Richard P. Dickey, M.D., Ph.D. Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology, Louisiana State University School of Medicine, New Orleans, New Orleans, LA 70128, USA Reply: letter to the editor夞 Sirs, Thank you for giving me the opportunity to respond to Professor Dickey’s letter, which raised some interesting points. As explained in the Materials and Methods section of the article [1], the study used data from a recent oral contraceptive (OC) compliance survey. The survey did not have the body weight information for the respondents; however, information about the pill brand used was available for the current OC users but not for the women who discontinued OC use. This limits the scope of addressing the issue of relationship between the pill’s steroidal content and the occurrence of side effects. Of the women who continued OC use (n ⫽ 801), about 63% were using high dose pills (50 g/day of ethinyl estradiol or mestranol), and about 37% were using low dose pills (30 –35 g/day of ethinyl estradiol or mestranol) [2]. However, at least one side effect was experienced by more than half of the OC users during the first three months of their OC use (459 of 801). An attempt was made to examine the association between the pill’s steroidal estrogen (such as ethinyl estradiol or mestranol) dose and the occurrence of side effects. The analysis revealed no evidence of relationship; however, dizziness and weakness were slightly more prevalent among the low dose pill users compared to their high dose pill users counterparts without statistical significance. Nevertheless, the survey was not designed to assess such an association and a clinical study of the relationship
0010-7824/02/$ – see front matter © 2002 Elsevier Science Inc. All rights reserved. PII: S 0 0 1 0 - 7 8 2 4 ( 0 2 ) 0 0 3 0 1 - 3
448
Letter to the Editor / Contraception 65 (2002) 000 – 000
of side effects to the pill’s steroidal contents will be a very interesting research topic. M. Azaduzzaman Khan School of Health, University of New England, Armidale, NSW 2351, Australia
References [1] Khan MA. Side effects and oral contraceptive discontinuation in rural Bangladesh. Contraception 2001;64:161–7. [2] Manual for birth control oral contraceptives, Norplant, and condom (In Bangali). Family Planning Clinical Services Project. Dkaha: Directorate of Family Planning, Government of the Peoples’ Republic of Bangladesh, September 1995. 夞 PII of original article S0010-7824(01)00302-5.