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Fertility control with drugs.

The use of drugs in controlling fertility is discussed. The oral contraceptives generally available in the U.S. are the combined agents and sequential preparations. Their side effects are a drawback of their use but many women are willing to tolerate the minor side effects. The possibility of oral contraceptives being associated with thrombophlebitis and other vascular complications needs further study. A statistical comparison of "hormone-linked" neoplasms in women who do and do not use the pill is needed to investigate whether oral contraceptives tend to increase the incidence of pelvic or breast malignancy. It is agreed that oral contraceptives may produce alterations in glucose tolerance but the significance of these alterations is controversial. Possible changes in lipid metabolism liver function pituitary activity and opthalmologic problems have also been studied in connection with oral contraceptive use. Attempts have been made to reduce the amount of hormonal agents needed for contraception. With the minidose pills the side effects seem to be minimal but the effectiveness is not equal to that of the combined or sequential preparations currently used. Among other methods of contraception that may soon become available are hormonal injections in the form of: 1) a combination of long-acting estrogen and progestogen given once a month or 2) a potent progestogen given once every 90 days. A major problem with the first method is that about 25% of treated women do not have normal-length cycles; with the second method there has been severe and persistent bleeding. The morning-after pill is another new development which has been primarily tested in animals. It is noted that the availability of new contraceptives does not necessarily mean replacement of older methods but rather increases the total use of contraception and provides a wider choice.