Severe Adverse Effects of Oral Contraceptives

Question 1

Which are the Severe Adverse Effects of oral contraceptives?

Answer 1

● Cardiovascular disorders
● Venous thromboembolic disease
● Myocardial Infarction
● Cerebrovascular Disease
● Liver Disorders
● Cancer

Question 2

What are the characteristics of Cardiovascular disorders?

Answer 2

● Risk appears to be concentrated in women 35y/o or older and who are heavy smokers

Question 3

What are the characteristics of Myocardial Infarction?

Answer 3

● The progestin component of O.C.s decrease HDL cholesterol, in proportion to the androgenic activity(C-19 1st gen) of progestin.

Question 4

What are the characteristics of Cerebrovascular Disease?

Answer 4

● Risk of stroke in women over 35y/o

Question 5

What are the characteristics of Liver Disorders?

Answer 5

● 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

Question 6

What are the characteristics of Cancer?

Answer 6

● Combination est. and prog. reduce !! the risk of ovarian and endometrial cancer (even after stop pills)
● The daughters of women who used DES during pregnancy have a higher incidence of vaginal and cervical cancer

Question 7

What are the characteristics of Venous thromboembolic disease?

Answer 7

● Estrogen-related

● OC use decreases serum antithrombin III levels