Gallbladder disease oral contraceptives

Vessey M, Painter R. Oral contraceptive use and benign gallbladder disease revisited. Contraception 1994 50(2) 167-73. 

These potential benefits are balanced by a slightly increased risk of gallbladder disease, hypertension, myocardial infarction, cerebral infarction, and pulmonary embolism. The increased risk of stroke and heart attack associated with the pill is accentuated when compounded by other risk factors, including smoking, migraine headaches, and advancing age. Indeed, convincing data support an upper age limit of 35 years for oral contraceptive use by women who smoke. 

Jaundice as a result of oral contraceptive treatment has been repeatedly described. Whereas in the Swedish population figures between 1 100 and 1 4000 were published when the early high-dose formulations were still in use (213), the overall incidence was estimated in 1979 at about 1 10 000 (9), and the current incidence is certainly further reduced. When such hepatic symptoms occur, they usually do so within the first month of medication (214), and jaundice may be accompanied by anorexia, malaise, and pruritus. Very few cases arise after the third month of medication and those reported are regarded by some as unlikely to be due to oral contraceptives. Microscopic examination of the liver shows intrahepatic cholestasis. When medication is stopped, symptoms usually disappear rapidly and the reaction does not seem to leave any sequelae (215). Genetic components seem to be important for the development of the reaction women who have experienced jaundice or severe pruritus in late pregnancy seem to be especially susceptible to jaundice or gallbladder disease when using... 

Strom BL, Tamragouri RN, Morse ML, Lazar EL, West SL, Stolley PD, Jones JK. Oral contraceptives and other risk factors for gallbladder disease. Clin Pharmacol Ther 1986 39(3) 335 U. 

Thijs C, Knipschild P. Oral contraceptives and the risk of gallbladder disease a meta-analysis. Am J Public Health 1993 83(8) 1113-20. 

Anonymous. Oral contraceptives aud veuous thromboembolic disease, surgically coufirmed gallbladder disease, aud breast tumours. Report from the Bostou Collaborative Drug Surveillance Programme. Laucet 1973 l(7817) 1399-404. 

Because most hot flashes resolve in 1 to 3 years, short-term use may be all that is needed, and can significantly improve quality of life. Short-term use, however, may increase the risk for cardiovascular events due to thrombogenesis and coronary heart disease, and should generally be avoided in women with preexisting cardiovascular disease, prior history of blood clots, or any condition that increases the risk for thrombotic events. With each year of use the risk for breast cancer and gallbladder disease increases. Long-term use decreases the risk for colon cancer and hip fracture. The side effects, contraindications, and drug interactions with HRT are similar to those for oral contraception (see Case 34). 

Other relative contraindications should be considered on an individual basis, including migraine headaches, hypertension, diabetes mellitus, obstructive jaundice of pregnancy or prior oral contraceptive use, and gallbladder disease. If elective surgery is planned, many physicians discontinue oral contraceptives for several weeks to minimize the possibility of thromboembolism. These agents should be used with care in women with prior gestational diabetes or uterine fibroids low-dose pills are preferred in such cases. 

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