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Beware Ladies! 

Hazards of Oral Contraceptives 

"Iatrogenic Disease"

Dr Sampurna Roy MD

 

 

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The most important contemporary drugs with many dangerous side effects are the oral contraceptives. 

Oral contraception is used worldwide by millions of women due to its easy availability as well as relative ease and safety of taking.

Almost all current formulations are combinations of synthetic estrogens and steroids with progesterone-like activity.

What is the mode of action of these pills?

The oral contraceptives act by either inhibiting the surge of gonadotropins in midcycle, thereby preventing ovulation, or inhibiting implantation by altering the phase of the endometrium.

The gonadotropins are Follicular stimulating hormone (FSH) and luteinizing hormones (LH) and they stimulate the Gonads - (Ovaries in female and testes in male).

After intake of pills the FSH secretion is depressed and LH peak is abolished. Urinary androgen excretion is much increased and this adds to the contraceptive effect.

Changes in cervical mucus make sperm penetration less likely.

All these effects are the result of synergistic action between the oestrogen and progestogen.

Hazards of Oral Contraceptives: (Iatrogenic Disease)

1) Thromboembolism:

This appears to be due to estrogen and is dose related.

Some of the main vascular complications include stroke, retinal artery thrombosis  pulmonary embolism, myocardial infaction, hepatic vein thrombosis (Budd-Chiari syndrome), mesenteric thrombosis and thrombophlebitis.

 

       

2) Myocardial Infarction and Stroke:

It has been claimed that oral contraceptives users run fourfold risk of myocardial infarction and stroke, specially in women over 35 who smoke.

Arterial disease is attributed mainly to effects of the progestogens.

It has been known for some time that oral contraceptives alter characteristics of lipoproteins in the direction of vascular disease.

 

3) Hypertension

4) Hepatobiliary complications -

Cholestatic jaundice ; Hepatic adenoma ; Gallstones.

Benign liver adenomas occur in a number of patients.

The incidence is higher in women who have used oral contraceptives for more than 5 years.

5) Oral contraceptive and neoplasia -

i) Breast Cancer -

Progesterone stimulated mitotic activity in breast epithelium and evidence has been published which suggest that long lasting oral contraceptive users before 25, specially with more potent progestogens, may incur an increased risk of subsequent breast cancer.

ii) Cervical Cancer -

Evidence has been offered to suggest that long term oral contraceptive users run a greater risk of cervical cancer and dysplasia, perhaps because the steroid hormones reduce immunity to antigenic causal factors.

Long term users should certainly have cervical cytology examination.

6) Other minor complications-

Nausea, headache, weight gain, insulin resistance (this can be a major complication in case of diabetes) and acne.

 

Contraindications to oral contraceptive use in patients in the following conditions:

-  History of vascular disease (thromboembolism, thrombophlebitis, atherosclerosis, and stroke),

-  History of systemic vascular disease (lupus erythematosus, sickle cell disease), hypertension, diabetes mellitus with vascular disease and hyperlipidemia.  

- Patients who suffer from an estrogen-dependent tumour, such as cancer of the breast or endometrium, should probably not take oral contraceptives, although there are no data showing an ill effect.

- Pregnancy is a contraindication because of the masculinizing effect of the on the external genitalia of the female fetus.

-  Patients with heart disease may develop congestive heart failure because of fluid retention.

- Women with active liver disease should not take oral steroids because they are metabolized in the liver.

- Those over the age of 45 should not take oral contraceptives except in unusual circumstances.

 

Further reading:

Oral contraceptives, risks and hazards.

Risk factors for recurrent venous thromboembolism in young and middle-aged women.

Oral contraceptives and the risk of gallbladder disease: a comparative safety study.

Risk-benefit assessment of the combined oral contraceptive pill in women with a family history of female cancer.

 

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Dr  Sampurna Roy  MD

Consultant Histopathologist (Kolkata - India)

 

 


 

 

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