Side effects & contraindications to medications

Question 1

Combined oral contraceptive pill

Answer 1

Absolute Contraindications

• CVD RF’s
  1. CVD or CAD
  2. Uncontrolled HTN
  3. Prior thromboembolic events, thromboembolic disorders (Factor V Leiden mutation; protein C, S or antithrombin III deficiency), active thrombophlebitis
  4. Congenital hypertriglyceridemia
  5. Migraines with focal neurological symptoms (excluding aura)
  6. >35 years + smoker

Pregnancy-related factors
1. Known/suspected pregnancy

Women’s health

1. Undiagnosed abnormal vaginal bleeding
2. Estrogen-dependent tumours (breast, uterus)

Other
1. Impaired liver function associated with acute liver disease

Question 2

Side effects of Estrogen in combined OCP

Answer 2

1. Weight gain (rare)
2. Nausea
3. Headaches/migraine
4. Thromboembolic events
5. Breast changes (tenderness, enlargement)
6. Fluid retention/bloating/edema
7. Liver adenoma (rare)
8. Breakthrough bleeding (low estradiol levels) ~ resolves after 3 cycles

Question 3

Side effects of Progesterone in combined OCP

Answer 3

1. Weight gain (as a result of increased appetite)
2. Mood changes
3. Headaches
4. HTN
5. Breast tenderness
6. Decreased libido
7. Amenorrhea/breakthrough bleeding - ~ resolves after 3x
8. Acne/oily skin*
9. Hirsutism*
   * Androgenic SE may be minimized by prescribing formulations containing desogestrel, norgestimate, drospirenone or cyproterone acetate