Conclusion - adverse effects of Hormonal contraception

The world population is expected to increase by 2.6 billion to 9.1 billion in 2050 ⁽¹⁾. Particularly, the developing countries contribute to this growth with consequent increase of their social and economic problems. So, this overpopulation stresses the discrepancy between developed and developing states.

The report "The Evolution of the Family in Europe 2008" declares that over 1.16 milion of legal abortions are performed each year in Europe. The real global incidence is unknown and each supposed percentage results underestimated.

Besides, an estimated 19 million unsafe abortions occur worldwide each year,resulting in the death of about 70,000 women.

The majority of these abortion occur in under-resourced settings as sub-Saharan Africa, Central and Southeast Asia, and Latin America and the Caribbean.

The causes include inadequate delivery systems for contraception, restrictive abortion laws, cultural and religious influences ^(2,3,4).
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With worldwide unintended pregnancy rates approaching 50% of all pregnancies, there is an increased need for the improvement of hormonal contraception acceptability, compliance and continuation.

Currently, pharmacological methods of contraception are reversible contraceptive steroids formulated in pills, patches, intravaginal rings, subdermal implants and injections^(5,6).

Despite the safety profile of current COCs, fears of adverse metabolic and vascular effects caused by estrogen component, and possible neoplastic effects of these formulations remain. Misperceptions and concerns about side-effects, especially those affecting the menstrual cycle and increased body weight, are often given as reason for discontinuation. However, these disorders are not clinically significant. They can lead to erratic method use or even to discontinuation⁽⁷⁾.
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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⁾.
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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.