Particularly, a report showed the occurrence of vena cava inferior thrombosis,renal vein thrombosis and pulmonary embolism due to inherited protein C deficiency in a 18-year old woman treated with HCs for three months (14). Similarly, cases of Budd-Chiari Syndrome in carriers of antithrombin III deficiency with a current or past history of oral contraceptive use had been reported (15,16).
The increase in blood pressure associated with HCs administration is generally mild and usually seen during the first or the second year of use. It is prudent to monitor blood pressure at least every 6 months in women receiving combined hormonal contraceptives, and it is mandatory in women over 35.
Furthermore, it is important to consider if the woman smokes or if she has some lipid anomalies.
Adverse Effects of Hormonal contraception
- Cardiovascular Effects
- - Myocardial Infarction
- - Stroke
- - Arterial Accidents
- - Venous Thromboembolism
- - Blood Hypertension
- Other Effects
- - Angioedema
- - Peliosis Hepatis
- - Severe Adverse Ocular Reactions
- - Vasculitis
- Moderate adverse effects
- Cancer Risks
- - Breast cancer risk
- - Ovarian cancer risk
- - Endometrial cancer risk
- - Cervical cancer risk
- - Colorectal cancer risk
- - Skin cancer risk
- - Liver cancer risk
- - Pancreatic cancer risk
- - Neurofibromas growth
- - Unclear cancer risks
- Hazardous prescription
- Hormonal contraception in female transplant recipients
- - Hormonal contraception in female kidney recipients
- - Hormonal contraception in female liver transplant recipients
- - Hormonal contraception in female heart transplant recipients
- - Contraception in women HIV infected
- Mild Adverse effects
- New Perspectives immunocontraception
- Contraceptive counseling
In fact, women who take HCs have an increased risk of developing new hypertension, which returns to baseline within 1 to 3 months of HC cessation (17).
However, some cases of irreversible hypertension, kidney failure and malignant nephrosclerosis have been reported (18,19). Women with pre-existing hypertension who take HCs have an increased risk of stroke and myocardial infarction when compared with hypertensive women who do not (20).
Most women with congenital cardiac disease can safely use oral contraceptives, especially low-estrogen combination or progestin-only preparations.
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 are very effective, have no metabolic side effects and merely carry a small risk of endocarditis. Newer devices containing progesterone only may put the patients at a still smaller risk. Contraceptive subdermal implants (e.g. levonorgestrel) are used with good results in the United States for patients with contraindications to estrogen-containing oral contraceptives (21).
Smoking increases the risk of hypertension by some 2 to 3 times. Smoking increases the risk of vascular damage by increasing sympathetic tone, platelet stickness and reactivity, free radical production, damage of endothelium, and by surges in arterial pressure (22,23). Almost 18% of the women suffering from migraine headaches and this data explains as the gynaecologyst will often be asked by their patients to prescribe hormonal contraceptives.
Several evidences showed that migraine is a contraindication to hormonal contraception in all women with aura and those aged 35 or older (24).
The use of highly effective reversible contraceptives is important for women with health issue, yet sometimes those same illnesses make the contraceptives themselves less effective or less safe. Common conditions are: systemic lupus erytematosus,uncontrolled diabetes mellitus, anticonvulsivant use for epilepsy or mood disorders, HIV infection, migraine headache, and obesity (25).
In addition, vitamin C in amounts of 1g/day has been found to intensify the action of contraceptives by enhancing systemic estrogen action. The tuberculostatic drug rifampicin reduces the breakdown of estrogen and progestin components for oral contraceptives. Antibiotics or sulfonamides seem reduce effectiveness of contraceptives by slowing reabsorption of estrogens due to reduced intestinal microflora (26,27).