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Oral Contraceptives Print E-mail

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Contraindications (a medication or procedure that is not advisable) and Adverse Effects.

These hormone-like drugs have been associated with many adverse effects; they are contraindicated in some situations and should be used with caution in others.

Absolute Contraindications

  • Pregnancy
  • Thrombophlebitis or thromboembolic disorders (past or present)
  • Stroke or coronary artery disease (past or present)
  • Cancer of the breast (known or suspected)
  • Undiagnosed abdominal vaginal bleeding
  • Estrogen-dependent cancer (known or suspected)
  • Benign or malignant tumor of the liver (past or present)

Relative Contraindications

  • Age over 35 years or heavy cigarette smoker (>15 cigarettes daily)
  • Migraine or recurrent persistent severe headache
  • Hypertension
  • Cardiac or renal disease
  • Diabetes
  • Gallbladder disease
  • Obstruction in the bile duct
  • Active hepatitis or infectious mononucleosis
  • Sickle cell disease
  • Surgery, fracture, or severe injury
  • Lactation
  • Significant psychological depression

Some women report some relatively minor side effects when they use “the pill”. There might be weight gain, acne, irritability, anxiety, thinking problems, lost hair, and so on. Those can be very irritating, but there are other, less well-known side effects that make the use of birth control bills unappealing, if not downright dangerous.

  • Myocardial Infarction (Heart Attack): The risk of heart attack is higher with use of oral contraceptives, particularly with pills containing 50 micrograms of estrogen or more. Cigarette smoking, obesity, hypertension, diabetes, or hypercholesterolemia increase the risk even further. Young nonsmoking women have less increased risk of heart attack. Smokers over age 40 and women with other cardiovascular risk factors should use other methods of birth control.
  • Thromboembolic Disease (blood clots): An increased rate of venous thromboembolism (a condition in which a blood clot fragment breaks off from one part of the body and blocks a blood vessel in another part of the body.) is found in oral contraceptive users, especially if the dose of estrogen is 50 micrograms or more. While the overall risk is very low (15 per 100,000 woman), several recent studies have reported a twofold increased risk in women using oral contraceptives containing the progestins gestodene or desogestrel compared with women using oral contraceptives with levonorgestrel and norethindrone. Women who develop thrombophlebitis should stop using this method, as should those at risk of thrombophlebitis because of surgery, fracture, serious injury, or immobilization.
  • Cerebrovascular Disease: Overall, a small increased risk of hemorrhagic stroke and subarachnoid hemorrhage and a somewhat greater increased risk of thrombotic stroke has been found; smoking, hypertension, and age over 35 years are associated with increased risk. Women who develop warning symptoms such as headache, blurred or lost vision, or other transient neurologic disorders should stop using oral contraceptives.
  • Carcinoma (Cancer): A relationship between long-term (3-4 year) oral contraceptive use and occurrence of cervical dysplasia and cancer has been found in various studies. A recent study has suggested the possibility of an increased risk of breast cancer in women who have ever used oral contraceptives if they have first-degree relatives with breast cancer. Rarely, oral contraceptives have been associated with the development of benign or malignant hepatic (liver) tumors; this may lead to rupture of the liver, hemorrhage, and death. The risk increases with higher dosages, longer duration of use, and older age.
  • Metabolic Disorders: A decrease in glucose tolerance (diabetes) and an increase in triglyceride levels is seen in pill takers, and women with diabetes using this method should be carefully monitored.
  • Hypertension (High Blood Pressure): Oral contraceptives may cause hypertension in some women; the risk is increased with longer duration of use and older age. Women who develop hypertension while using oral contraceptives should use other contraceptive methods.
  • Headache: Migraine or other vascular headaches may occur or worsen with pill use. If severe or frequent headaches develop while using this method, it should be discontinued.
  • Amenorrhea (absence of menstrual periods): a lasting a year or longer occurs occasionally, sometimes with galactorrhea (a spontaneous flow of milk from the nipple.) Prolactin levels should be checked; if elevated, a pituitary prolactinoma (a tumor in the pituitary gland) may be present.
  • Disorders of Lactation: Combined oral contraceptives can impair the quantity and quality of breast milk.
  • Other Disorders: Depression may occur or be worsened with oral contraceptive use.

Regardless of the reason for using a birth control pill, all women need to understand and be on the lookout for symptoms that may be associated with a severe reaction. Two basic approaches are avoid smoking and use a quality brand of a multiple vitamin, particularly one that contains a good daily dose of B vitamins (Ortho's Ortho B Complex is excellent). In addition, use a quality probiotic to boost the immune system. We recommend Florajen 3.

 
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