Adverse Effects of Hormonal contraception

Hormonal contraception has been an available method of birth control for over four decades Despite this, women's knowledge often moves between myth and reality, and never has another medical finding aroused over similar controversial opinions.

Misperceptions, previous personal experience, suggestion by poor experience from other women and influence of mass media, sometimes contribute to noncompliance or drop-out of the used hormonal contraceptive method because of the user's rational or irrational anxieties ⁽¹⁾.

In fact, this flash-information may lead to a clearcut relationship between negative suggestion and the incidence of emotional refusal ⁽²⁾.

Particularly, the mass media continue to show an ambiguous behaviour enhancing the health risks of COCs use with a generic and uncritical manner or emphasizing the good effects of the hormonal contraceptives without informing about their risks. In addition, the current international influence by pharmaceutical companies on one part of the research can contribute to minimize many adverse outcomes of the sexual steroids and to limit a widespread scientific information.

It is known that biological and psychological changes are linked to hormonal contraception,and their adverse effects can play an important role in determining acceptability ⁽³⁾.

Actually, hormonal contraceptives (COCs) contain both estrogen and progestin or progestin alone. In 1964, ethinyl estradiol (EE) a better tolerated synthetic estrogen, replaced mestranol and, at the moment, is still used.
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Oral EE, 200 times more potent than estradiol, exerts its action, primarily dose-dependent, on the estrogen-target organs and tissues (endometrium, mammary epithelium, liver, haemostasis and lipid levels).

Furthermore, the estrogen primarily controls the menstrual bleeding. Estrogen and progestin work synergically to inhibit ovulation.

The androgenic action of progestins, reflected in reduction of HDL cholesterol, is an important factor in occurrence of arterial accidents ⁽⁴⁾.

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In the Rosa Sabatini early 1980s, the third generation oral contraceptives were developed in an attempt to decrease the risk of cardiovascular disease (CVD) and to decrease androgenic side-effects such as weight gain, acne and adverse changes in metabolism of lipoproteins.

Although the major disadvantage of third generation COCs, according with the majority of authors, is the increased risk of vascular effects ^(5,6).

Anyway, the third-generation 19-nortestosterone derivatives (gestodene, desogestrel, norgestimate), allowed the reduction of the COCs steroid doses.
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