Contraceptives adverse effects

A woman experienced increased combined oral contraceptive adverse effects whiie taking nefazodone. 

Thus, our attention should shift from the concern of potential adverse effects to the health benefits imparted by hormonal contraceptives. The use of oral contraceptives for at least 12 months reduces the risk of developing endometrial cancer by 50%. Furthermore, the risk of epithelial ovarian cancer in users of oral contraceptives is reduced by 40% compared with that on nonusers. This kind of protection is already seen after as little as 3-6 months of use. Oral contraceptives also decrease the incidence of ovarian cysts and fibrocystic breast disease. They reduce menstrual blood loss and thus the incidence of iron-deficiency anemia. A decreased incidence of pelvic inflammatory disease and ectopic pregnancies has been reported as well as an ameliorating effect on the clinical course of endometriosis. 

While there are many non-contraceptive benefits associated with the use of combined oral contraceptives, their use is not without risk or potential for adverse effects. 

As with all medications, there are potential adverse effects with combined oral contraceptives (COCs). Many side effects can be minimized or avoided by adjusting the estrogen and/or progestin content of the oral contraceptive. It is also important to have proper patient selection for oral contraceptives because some women are at increased risk for potentially serious side effects. 

As an alternative to hormonal contraceptives, several barrier contraceptive options are available for the prevention of pregnancy. While barrier contraceptives are associated with far fewer adverse effects compared with hormonal contraceptives, their efficacy is highly user-dependent. Overall, compared with both hormonal contraceptives and IUDs, barrier contraceptives are... 

Adverse effects include nausea, weight gain, breast tenderness, and breakthrough bleeding. Oral contraceptives have also been associated with an increased incidence of thromboembolic disease, particularly in women who use tobacco products or have other risk factors for thromboembolism. The development of these complications is significantly reduced when low-dose estrogen formulations of oral contraceptives are used.3... 

Toxicities are GI (stomatitis, diarrhea, nausea, vomiting), hematologic (thrombocytopenia, leukopenia), pulmonary (fibrosis, pneumonitis), and hepatic (elevated enzymes, rare cirrhosis). Concomitant folic acid may reduce some adverse effects without loss of efficacy. Liver injury tests (aspartate aminotransferase or alanine aminotransferase) should be monitored periodically, but a liver biopsy is recommended during therapy only in patients with persistently elevated hepatic enzymes. MTX is teratogenic, and patients should use contraception and discontinue the drug if conception is planned. 

Adverse Effects of Combined Hormonal Contraception (CHC) and Management"... 

Adverse effects associated with combined hormonal contraceptives (CHCs) and their management are shown in Table 30-3. 

Indications for estrogens and pro-gestins include hormonal contraception (p. 256), hormone replacement, as in postmenopausal women for prophylaxis of osteoporosis bleeding anomalies, menstrual complaints. Concerning adverse effects, see p. 256. 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

Adverse effects are uncommon although diarrhea and abdominal cramping in up to 30% of patients may limit its use. Misoprostol should be avoided in pregnant subjects and women of childbearing potential should be advised of adequate contraception as misoprostol may cause miscarriage. Effects on the developing human fetus are not known. 

The one product obtained from cottonseed oil, Gossypol which is categorized as non-hormonal selective spermatogenesis suppressant, is effective in producing azoospermia or severe oligospermia but it is not widely used as male contraceptive. Mechanism of action is not known. Adverse effects are edema, diarrhoea, hypokalemia, neuritis. 

Adverse effects of variable severity have been reported with the therapeutic use of estrogens. Many other effects reported in conjunction with hormonal contraceptives may be related to their estrogen content. These are discussed below. 

The incidence of serious known toxicities associated with the use of these drugs is low—far lower than the risks associated with pregnancy. There are a number of reversible changes in intermediary metabolism. Minor adverse effects are frequent, but most are mild and many are transient. Continuing problems may respond to simple changes in pill formulation. Although it is not often necessary to discontinue medication for these reasons, as many as one third of all patients started on oral contraception discontinue use for reasons other than a desire to become pregnant. 

Pregnancy can be prevented following coitus by the administration of estrogens alone, progestin alone, or in combination ("morning after contraception). When treatment is begun within 72 hours, it is effective 99% of the time. Some effective schedules are shown in Table 40-4. The hormones are often administered with antiemetics, since 40% of the patients have nausea or vomiting. Other adverse effects include headache, dizziness, breast tenderness, and abdominal and leg cramps. 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

Warnings Increased susceptibility to infection and lymphoma Adverse effects on fetal development have been observed in pregnant rats and rabbits—mycophenolate mofetil should not be used in pregnant women and contraception should be used during therapy Neutropenia has been observed... 

Oral contraception and hormone replacement therapy are dealt with specifically in separate monographs. Here the general adverse effects of estrogens for any indication are reviewed. 

Diethylstilbestrol has been widely used as a post-coital contraceptive. However, it is no longer in use in many countries for this purpose, because of the possible adverse effect on the development of a surviving fetus (see separate monograph). 

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