Side Effects of Oral Contraceptives

Question 1

What are the side effects of oral contraceptives?

Answer 1

● Nausea, Mastalgia, Edema
● Depression
● Migranes
● Breakthrough Bleeding
● Androgenic Side Effects
● Chloasma
● Uretal dilation / Effects on uterus and vagina
● Impaired liver function and jaundice
● Gall bladder

Question 2

What are the characteristics of Nausea, Mastalgia, Edema?

Answer 2

● Estrogen-induced

Question 3

What are the characteristics of Depression

Answer 3

● Progestins induce enzyme that cleaves/destroys tryptophan (which is serotonin precursor) – so decreased CNS serotonin levels = depression

Question 4

What are the characteristics of Migranes?

Answer 4

● Estrogen-induced (due to estrogen component)

Question 5

What are the characteristics of Breakthrough Bleeding?

Answer 5

● More common with progestin-only OC
● Combination OC’s:
Bleeding early in cycle – b/c of too little estrogen
Bleeding later in cycle – b/c of too little progestin

Question 6

What are the characteristics of Androgenic Side Effects?

Answer 6

● C-19 (1st generation) progestin-induced

● Ex: weight gain, hirsutism, acne, oily skin

Question 7

What is Chloasma?

Answer 7

● Estrogen-induced pigmentation of skin

Question 8

What are the characteristics of Uretal dilation / Effects on uterus and vagina?

Answer 8

● Increased bacteruria and vaginal infections, but decreased incidence of pelvic inflammatory disease (PID) b/c thick mucosa prevent bacteria penetration

Question 9

What are the characteristics of Impaired liver function and jaundice?

Answer 9

● C-19 progestins can induce cholestatic jaundice, although rare (obstruction of bile exit portals in liver)

Question 10

What are the characteristics of Gall Bladder side effects?

Answer 10

● Estrogen-induced → estrogens increase cholesterol secretion into bile, but decrease bile acid secretion leading to increased saturation of the bile with cholesterol; this is responsible for: gallstone formation and perhaps gall bladder disease