Severe Adverse Effects of Oral Contraceptives Flashcards
Which are the Severe Adverse Effects of Oral Contraceptives?
- Cardiovascular disorders
- Venous thromboembolic disease
- Myocardial Infarction
- Cerebrovascular Disease
- Liver Disorders
- Cancer
How - Cardiovascular disorders?
● Risk appears to be concentrated in women 35y/o or older & who are heavy smokers
How - Venous thromboembolic disease?
● Estrogen-related
● OC use decreases serum antithrombin III levels
● Estrogens increase certain clotting factors
● Surprisingly , incidence does not appear to be
related to age or smoking habits
How - Myocardial Infarction?
● The progestin component of O.C.s decrease HDL cholesterol, in proportion to the androgenic activity(C-191s t gen)ofprogestin.
● Smokers are definitely at increased risk of MI
● Estrogens increase clotting factors
How - Cerebrovascular Disease?
● Estrogen-related ??
● Risk of stroke in women over 35y/o
How - Liver Disorders?
● C-19 progestins with C17-α–alkyl substituents have been known to induce cholestatic jaundice (liver event – obstruction of bile exit portals) while estrogens normally decrease bile secretion and flow →therefore both components of combined OC’s may ultimately contribute to the rare incidence s of jaundice that have occurred in O.C. users
● In patients with current liver impairments or current liver tumor, use a progestin-only OC because these patients have greatly impaired ability to metabolize steroids and the danger is that the estrogen component of combination OC’s would build-up to unacceptable levels → remember that most of the serious side effects of OC’s are due to the estrogen component
How - Cancer?
● Combination est. & prog. reduce!! the risk of ovarian & endometrial cancer (even after stop pills)
● May(??) be an increased risk of breast cancer in younger women
● The daughters of women who used DES during pregnancy have a higher incidence off vaginal and cervical cancer
