Estrogens contraceptives with breast

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... 

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Women who particularly benefit from progestin-only methods, including minipills, are those who are breast-feeding, those who are intolerant to estrogens, and those with concomitant medical conditions in which estrogen is not recommended. Also injectable and implantable contraceptives are beneficial for women with compliance issues. 

In the same way as estrogens, progestogens are used in the treatment of several other conditions such as infertility, endometriosis, in the management of certain breast and endometrial cancers, and either alone or in combination with estrogens in the treatment of menstrual disorders, among others. The therapeutic doses required in the treatment of many of these diseases are often significantly larger than those employed in contraception. 

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. 

Breast tenderness or pain can occur in some women (255,256), especially with estrogen-dominant formulations, although it is notable that other women with a history of breast discomfort experience improvement when they begin to take oral contraceptives. 

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