Hormonal contraceptives adverse effects

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. 

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 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. 

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. 

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. 

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. 

Hormonal contraception relies on the actions of estrogens and progestogens, of which oral contraceptives contain a mixture. The adverse effects of the separate components are discussed in other monographs. 

Most aspects of progestogens are dealt with in the monograph on hormonal contraception. For a complete account of the adverse effects of progestogens, readers should consult the following monographs as well as this one ... 

Progestogens given alone for contraceptive purposes can cause a number of adverse effects, some of which may reflect their other hormonal properties while others are non-specific. Headache, nausea and vomiting, breast tenderness, and pain in the back or abdomen can occur. 

In another study of the LNG-IUS in 200 young nulli-parous women, half of whom received the intrauterine system and the remainder an oral contraceptive for 1 year, 20% of those in the LNG-IUS group withdrew, one-third because of pain the adverse effects in the oral group, in which 28% withdrew, were hormonal (53). 

Although hormonal contraceptives provide an easy and effective means of birth control, their use has been limited somewhat by potentially serious side effects. In particular, contraceptive medications have been associated with cardiovascular problems such as thrombophlebitis, stroke, and myocardial infarction.153 The incidence of these adverse effects, however, seems to depend to a large extent on whether the user has other risk factors associated with cardiovascular disease (smoking cigarettes, hyperlipidemia, hypertension, and so forth).84,120,162 Likewise, cardiovascular risks may be diminished with the newer forms of hormonal contraceptives, which contain relatively less estrogen than their predecessors. 

Q7 What risk factors and potential adverse effects should be considered when using combined hormonal contraceptives ... 

Subdermal implantations that release hormone for several years are in use they can be removed surgically if adverse effects develop or pregnancy is desired. For example, a flexible rod containing etonorgestrel (Implanton) inserted into the lower surface of the upper arm provides contraception for 3 years (2 years for overweight women because they have lower blood concentrations). The rod must be removed when its effective period has elapsed. 

The antiprogesterone mifepristone, almost exclusively used as an abortifacient, has also been tried as a post-coital contraceptive (11). In one randomized comparative trial, a single dose of mifepristone 600 mg was at least as effective as the usual hormonal method (12). Women who took mifepristone had lower rates of adverse effects, particularly nausea and vomiting, but their next menstrual period was more likely to be delayed. In another randomized trial, both methods were equally effective (SEDA-16, 466). The use of an estrogen + a progestogen had a higher total incidence... 

The progestin-like drugs, their use in contraception and in hormonal replacement therapy, and their j adverse effects are considered. 

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