Hormonal steroid contraceptives. II. Clinical considerations.

Measured in terms of the problems of world population control, hormonal contraceptives have contributed little ;a mere 17 million women using them at the present time. However, in certain Western countries, notably Australi a, New Zealand and the United States of America, the impact of oral contraception has been considerable. In developing countries experience with hormonal steroids has been disappointing, mainly because motivation is poor and because supervision by medical or para-medical personnel is lacking. Thus, viewed in its relation to the world scene, hormonal contraception can be regarded as adding to the comfort and happiness of the people of nations who are already relatively comfortable and happy . In our society , the acceptance of oral contraception that has led to it becoming the most commonly used form of contraception depends on several factors. Foremost is effectiveness. The combined oestrogen-progestagen preparations are virtually 100 % effective when used correctly and sequential regimens are only marginally less so. There has been ready acceptance by the medical profession who have found the prescription of pharmacological agents to be more in keeping with their traditional approach to medicine than the dispensing of mechanical and other contraceptives for which they have often been poorly trained . Many minor side-effects attributed to hormonal stero ids are subjective in nature and susceptible to both user and observer bias. There is a paucity of adequately controlled studies from which conclusions can be drawn about the incidence of such symptoms, particularly those of a psychological kind. Nevertheless, certain side-effects such as nausea and oedema can be related to oestrogen, and others, such as reduced menstrual flow and migrainous headaches, can be related to progestagen.