Much of the woman’s dissatisfaction because of menstrual changes can be averted by careful counselling prior to method prescription.
Open dialogue explaining the potential for bleeding irregularities is crucial in this time, in order to avoid the discontinuation that places the woman at risk of unwilling pregnancy. The hormonal contraceptive prescription in some women at risk might be considered a hazard, but an expert individualized evaluation of gynecologist may consent it.
Most women with congenital cardiac disease can safely use oral contraceptives, especially low-estrogen combinations or progestin-only preparations(8).
Adverse Effects of Hormonal contraception
- Moderate adverse effects
- Cardiovascular Effects
- Other Effects
- Cancer Risks
- Contraception in women HIV infected
- Mild Adverse effects
- - Irregular Bleeding Pattern
- - Ovarian cysts
- - Depression
- - Low Libido
- - Vaginal Infections
- New Perspectives immunocontraception
- - PMRS and PAS
- Contraceptive counseling
Clearly, oral contraceptives should be avoided in all patients at particular risk of thromboembolic complications because of pulmonary hypertension, Eisenmenger syndrome, rhythm disturbances, reduced ventricular function, arterial hypertension, infectious complications (endocarditis) or hyperlipidemia.
Intrauterine devices-releasing progestin which are very effective, have no metabolic side effects and merely carry a small risk of endocarditis(9).
Other medical conditions require our attention. During hormonal contraceptive use, some cases of subhepatic vein thrombosis or the Budd-Chiari syndrome, associated to focal nodular hyperplasia as well as adenoma have been reported(10,11).
In the meantime, it is mandatory to avoid combined hormonal contraception in SLE patients with high levels of antiphospholipid antibodies and, in those with active nephritis(12,13).
In fact, these women, when use combined oral contraceptives are at high risk of thromboses (St. Thomas’ Hospital-London) (12,13). Progress in the area of female reproduction is showing great promise for identifying new contraceptives drug targets (14). Today, the properties of Selective progesterone receptor modulators (PRMs) and progesterone antagonists( PAs) open up new applications in contraceptive strategies introducing the new concept of “Endometrial Contraception”(15).
In the meantime, there is necessity to develop newer, possibly nonsteroidal and non hormonal contraceptives. Recent advancements in our understanding of ovarian endocrinology, coupled with molecular biology and transgenic technology, have enabled identification of several factors that are functionally critical in the regulation of female fertility.