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Appropriate contraception for middle-aged women

  • Robert B. Greenblatt (a1), Camran Nezhat (a1) and Virginia P. McNamara (a1)


The United States Food and Drug Administration and the International Planned Parenthood Federation recommend that women over the age of 40 should utilize forms of contraception other than the pill. This decision was reached as a result of the 1975 clinical papers by Mann and his associates (Mann et al., 1975; Mann & Inman, 1975) and the epidemiological reports of the Royal College of General Practitioners (1977), Mann, Inman & Thorogood (1976) and Vessey, McPherson & Johnson (1977). Several authoritative bodies believed it prudent to suggest that the age limit for oral contraceptive use be lowered to 35, and even to 30 years (Anon, 1977; Planned Parenthood memorandum, 1977). The investigations of Inman & Vessey (1968) point to a precarious rise in mortality figures for women over age 35 on oral contraceptives.



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Adamopoulos, D.A., Loraine, J.A., & Dove, G.A., (1971) Endocrinological studies in women approaching the menopause. J. Obstet. Gynaec. Br. Commonw. 78, 62.
Ambrus, J.L., Courey, N.G., Browne, B.J., Mink, I.B., Moore, R.H., & Ambrus, C.M., (1977) Progestational agents and blood coagulation. VIII. Effect of low-dose, alternate day, estrogenprogestin combinations on blood coagulation factors in man, with a special note on the effect of freezing of blood samples. Am. J. Obstet. Gynec. 128, 161.
Anderson, B., Connell, E., Kaplan, H.S., Kemeny, N., Notman, M., Perlmutter, J., Shainess, N., & Tyson, M.C., (1977) The reason for contraception. In: The Menopause Book, p. 24. Edited by Rose, L.. Hawthorn, New York.
Anon (1977) Editorial. Lancet, ii, 747.
Asch, R.G., Greenblatt, R.B., & Mahesh, V.B., (1978) Pure crystalline estradiol pellet implantation for contraception. Int. J. Fert. 23, 100.
Berger, G.S., (1977) Oral contraceptives and myocardial infarction. N.C. med. J. 38, 323.
Chez, R.A., Jaffe, R.B., Kase, N.G., & Plunkett, E.R., (1976) The sexually active premenopausal woman. Dialogues in Oral Contraception, 1, No. 6.
Costoff, A., (1974) An ultrastructural study of ovarian changes in the menopause. In: The Menopausal Syndrome, p. 12. Edited by Greenblatt, R. B., Mahesh, V. B. & McDonough, P. G.. Medcom Press, New York.
Davies, J.A., (1976) Workshop Report: Estrogens and clotting factors. In: Consensus on Menopause Research, p. 55. Edited by van Keep, P. A., Greenblatt, R. B. & Albeaux-Fernet, N.. MTP, Lancaster.
Drill, V.A., (1972) Oral contraceptives and thromboembolic disease. J. Am. med. Ass. 219, 583.
Elkeles, R., Hampton, J., & Mitchell, J., (1968) Effect of oestrogens on human platelet behaviour. Lancet, ii, 315.
Ellinas, S.P., (1977) Experience with medroxyprogesterone acetate as an injectable contraceptive. Int. J. Gynaec. Obstet. 14, 145.
Emperaire, J.C., & Greenblatt, R.B., (1969) L'Implantation de pellets d'oestradiol dans la contraception. Gynec. Prat. 5, 327.
Gambrell, R.D. Jr. (1978) The prevention of endometrial cancer in postmenopausal women with progestogens. Maturitas, 1, 107.
Gambrell, R.D. Jr, Castaneda, T.A., & Ricci, C.A., (1978) Management of postmenopausal bleeding to prevent endometrial cancer. Maturitas, 1, 99.
Geller, S., (1978) La Pilule, 20 Ans Apres. Mediprint, Marseille.
Goldzieher, J.W., & Dozier, T.S., (1975) Oral contraceptives and thromboembolism: a reassessment. Am. J. Obstet. Gynec. 123, 878.
Gordon, G.S., & Greenberg, B.G., (1976) Exogenous estrogen and endometrial cancer. Postgrad. Med. 59, 66.
Greenblatt, R.B., (1952) Dysmenorrhea. In: Office Endocrinology, p. 200. Thomas, Springfield, III.
Greenblatt, R.B., Asch, R.G., Mahesh, V.B., & Bryner, J.R., (1977) Implantation of pure crystalline pellets of estradiol for conception control. Am. J. Obstet. Gynec. 127, 520.
Greenblatt, R.B., Hammond, D.O., & Clark, S.L., (1954) Membranous dysmenorrhea: studies in etiology and treatment. Am. J. Obstet. Gynec. 68, 835.
Greenblatt, R.B., & Stoddard, L.D., (1978) Estrogen-cancer controversy. J. Am. geriat. Soc. 11, 1.
Hammond, C.B., Jelovsek, F.R., Lee, K.L., Creasman, W.T., & Parker, R.T., (1979) Effects of long-term estrogen replacement therapy. I. Metabolic. Am. J. Obstet. Gynec. (In Press.)
Hunter, S.J.D., Akande, E.O., Corr, P., & Stallworthy, J., (1973) The clinical and endocrinological effects of estradiol implants at the time of hysterectomy and bilateral salpingooophorectomy. J. Obstet. Gynaec. Br. Commonw. 80, 827.
Inman, W.H.W., & Vessey, M.P., (1968) Investigation of deaths from pulmonary, coronary and cerebral thrombosis and embolism in women of childbearing age. Br. med. J. 2, 193.
Inman, W.H.W., Vessey, M.P., Westerholm, B., & Engelung, A., (1970) Thromboembolic disease and the steroid content of oral contraceptives. A report of the Committee on Safety of Drugs. Br. med. J. 2, 203.
Jain, A.K., (1976) Cigarette smoking, use of oral contraceptives and myocardial infarction. Am. J. Obstet. Gynec. 126, 301.
Kaufman, S.A., (1969) Fertility and conception after age forty. Obstet. Gynec. N.Y. 3, 288.
Larsson-Cohn, U., (1976) Lipids and estrogens. In: Consensus on Menopause Research, p. 51. Edited by van Keep, P. A., Greenblatt, R. B. & Albeaux-Fernet, M.. MTP, Lancaster.
Lebech, P.E., & Borggard, B., (1974) Serum tipid and antithTombin-III changes effected by synthetic and natural estrogen therapy. In: The Menopausal Syndrome, p. 68. Edited by Greenblatt, R. B., Mahesh, V. B. & McDonough, P. G.. Medcom Press, New York.
Mack, T.N., Pike, M.C., Henderson, B.E., Pfeffer, R.I., Gerkins, V.R., Arthur, M., & Brown, S.E., (1976) Estrogens and endometrial cancer in a retirement community. N. Engl. J. Med. 294, 1262.
Mann, J.I., & Inman, W.H.W., (1975) Oral contraceptives and death from myocardial infarction. Br. med. J. 2, 245.
Mann, J.I., Inman, W.H.W., & Thorogood, M., (1976) Oral contraceptive use in older women and fatal myocardial infarction. Br. med. J. 2, 445.
Mann, J.I., Vessey, M.P., Thorogood, M., & Doll, R., (1975) Myocardial infarction in young women with special reference to oral contraceptive practice. Br. med. J. 2, 241.
Martinez-Manautou, J., Ramos, R.A., & Giner, J., (1974) The premenopausal woman: her fear of pregnancy and choice of contraception. In: The Menopausal Syndrome, p. 162. Edited by Greenblatt, R. B., Mahesh, V. B. & McDonough, P. G.. Medcom Press, New York.
Mauvais-Jarvis, P., (1978) La contraception, apres 40 ans. Gaz. med. Fr. 85, 3091.
McDaniel, E.B., & Pardthaisong, T., (1971) Return of menstruation and fertility in Thai women after contraceptive injections. J. biosoc. Sci. 3, 209.
Netter, A., & Lambert, A., (1975) Etude hormonal preliminaire de la premenopause, In: La Menopause, p. 28. Edited by Bernard, I., Kollenc, M. & Audebert, A.. Imprimerie E. Drouillard, Bordeaux.
Notelovrtz, M., (1977) Coagulation, oestrogen, and the menopause. In: Clinics in Obstetrics and Gynaecology, Vol. 4, p. 107. Edited by Greenblatt, R. B. & Studd, J. W. W., Saunders, London.
Notelovitz, M., (1978) Clotting factors and oestrogen replacement therapy. In: Female and Male Climacteric, p. 103. Edited by van Keep, P. A. & Greenblatt, R. B.. MTP. Lancaster.
Philips, J.M., (1977) Complications in laparoscopy. Int. J. Gynaec. Obstet. 15, 157.
Punnonen, R., & Rauramo, L., (1976) The effect of castration and oral estrogen therapy on serum lipids. In: Consensus on Menopause Research, p. 132. Edited by van Keep, P. A., Greenblatt, R. B. & Albeaux-Fernet, M.. MTP, Lancaster.
Royal College of General Practitioners (1977) Oral contraceptive study: mortality among oral contraceptive users. Lancet, ii, 727.
Sherman, B.M., West, J.H., & Korenman, S.H., (1976) The menopausal transition: analysis of LH, FSH, estradiol, and progesterone concentrations during menstrual cycles of older women. J. clin. Endocr. Metab. 42, 629.
Smith, D.C., Prentice, R., Thompson, D.J., & Herrmann, W.L., (1975) Association of exogenous estrogen and endometrial carcinoma. N. Engl. J. Med. 293, 1164.
Sturtevant, F.M., (1977) Comments on epidemiological studies relating myocardial infarction and oral contraceptives. In: Pharmacology of Steroid Contraceptive Drugs, p. 297. Edited by Garattina, S. & Berendes, H. W.. Raven Press, New York.
Thom, M., Dubiel, M., Kakkar, V.B., & Studd, J.W.W., (1978) The effect of different regimens of oestrogens on the clotting and fibrinolytic system of postmenopausal women. Front. Horm. Res. 5, 192.
Tietze, C., & Lewit, S., (1970) Evaluation of uterine devices. Ninth progress report of the cooperative statistical program. Stud. Fam. Plann. 55, 1.
Tietze, C., & Lewit, S., (1977) Mortality and fertility control. Int. J. Gynaec. Obstet. 15, 100.
Vessey, M.P., McPherson, K., & Johnson, B., (1977) Mortality among women participating in the Oxford/Family Planning Association contraceptive study. Lancet, ii, 731.
Ziel, H.K., & Finkle, W.D. (1975) Increased risk of endometrial carcinoma among users of conjugated estrogens. N. Eng. J. Med. 293, 1167.


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