title: Quantification of the adverse effect of ethinylestradiol containing oral contraceptive pills when used in conjunction with growth hormone replacement in routine practice.
abstract: OBJECTIVE
  Oestrogen antagonizes the action of growth hormone (GH). For women with combined GH and oestrogen deficiency, transdermal oestradiol is more favourable in this regard compared to oral oestradiol. Oral contraceptive pills containing ethinylestradiol (EE) are commonly used in young women with GHD and there is little information on the impact of this form of oestrogen.
  
  
  METHODS
  A case note review of women with growth hormone deficiency (GHD) attending a tertiary endocrine clinic comparing the dose of GH and serum insulin-like growth factor 1 concentrations and the type of exogenous oestrogen.
  
  
  METHODS
  All women with GHD between the ages of 18 and 47 attending University College London Hospitals (UCLH) were included and grouped according to type of oestrogen replacement. Weight, GH dose and serum IGF-I concentrations were recorded at 121 visits in 88 women.
  
  
  RESULTS
  The daily dose of GH was significantly higher and the GH responsivity was significantly lower in the EE group compared to those taking no oestrogen and transdermal oestrogen. The additional cost of GH for women using EE compared to transdermal oestradiol was £6016 per patient per year. Effectiveness of GH improved in all women changing from EE to another form of oestrogen.
  
  
  CONCLUSIONS
  Use of oral contraceptive pills containing EE should be avoided in women receiving treatment with GH. Alternative options include oral or transdermal hormone replacement therapy (HRT) preparations for those that require oestrogen replacement or a progesterone-based regimen for contraceptive purposes.
authors.affiliation: Department of Endocrinology, University College London Hospitals, London, UK.
authors.forename: Niamh
authors.initials: N
authors.lastname: Phelan
authors.forename: Sophy H
authors.initials: SH
authors.lastname: Conway
authors.forename: Sofia
authors.initials: S
authors.lastname: Llahana
authors.forename: Gerard S
authors.initials: GS
authors.lastname: Conway
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight / Q000187:drug effects; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000009:adverse effects / Q000172:deficiency / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy / Q000191:economics / Q000379:methods*; D019382:Human Growth Hormone / Q000037:antagonists & inhibitors / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D007271:Injections, Intradermal; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral; D003277:Contraceptives, Oral, Combined; D004967:Estrogens; D019382:Human Growth Hormone; D004997:Ethinyl Estradiol; D007334:Insulin-Like Growth Factor I