Contraindications (a
medication or procedure that is not
advisable) and
Adverse Effects (extracted from
Current Medical Diagnosis and Treatment,
2002.) Oral contraceptives 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
Cholestasis (an
obstruction in the bile duct)
during pregnancy
Active hepatitis or infectious
mononucleosis
Sickle cell disease (S/S or S/C
type)
Surgery, fracture, or severe injury
Lactation
Significant psychological depression
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.
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