Oral contraception side effects

Abramson FD, Schultz JS (1971) Oral contraceptive side-effects and allergy an immune aetiology Lancet 2 1374-1375... 

A final area of research focuses on how the piU. can best be used by women. Physicians used to recommend pid-free hoHdays, but it is now known that there is no vaUd reason for this practice. Similarly, further research indicated that the U.S. EDA s restrictive guidelines for prescribing the piU. to women over the age of 35 are not justified, and those guidelines have been changed. EinaHy it is clear that cigarette smoking increases the risk of cardiovascular side effects, especially in women over 35 who utilize combination oral contraceptives. 

S. Ramcharan, R. A. PeUegtin, R. M. Ray, and co-workers. The Walnut Creek Contraceptive Drug Study A Prospective Study of the Side Effects of Oral Contracptives, Vol. 3, U.S. Dept, of Health and Human Services, Government Printing Office, 1981. 

Drugs with endocrinological functions or side-effects are common, but oestrogenic hormones in oral contraceptives are particularly widely used. Pharmaceuticals and their metabolites eventually find their way into the environment, predominantly via excretion into sewage. ... 

Side effects associated with the use of combined oral contraceptives may be minimized by appropriately adjusting either the total estrogen or progestin content. 

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. 

Table 46-1 illustrates the pathophysiology of amenorrhea relative to the organ system(s) involved, as well as the specific condition that results in amenorrhea. Amenorrhea is also a normal side effect that may result from the use of low-dose oral contraceptives (OCs), extended-cycle OC pill use, or depot medroxyprogesterone acetate use.5 Many women may experience delayed return of menses after discontinuation of OCs. Postpill amenorrhea usually is a self-limited condition. Further evaluation for other unrecognized conditions, such as polycystic ovary syndrome (PCOS), should be considered if spontaneous resolution of the amenorrhea does not occur within 3 to 6 months following discontinuation of the OCs.6,7... 

Sustained- and controlled-release devices for drug delivery in the vaginal and uterine areas are most often for the delivery of contraceptive steroid hormones. The advantages in administration by this route—prolonged release, minimal systemic side effects, and an increase in bioavailability—allow for less total drug than with an oral dose. First-pass metabolism that inactivates many steroid hormones can be avoided [183,184],... 

The hormone-releasing devices have a closer resemblance to standard methods of sustained release because they involve the release of a steroid compound by diffusion [198,199]. The Progestasert, a reservoir system, is shown in Fig. 16. Progesterone, the active ingredient, is dispersed in the inner reservoir, surrounded by an ethylene/vinyl acetate copolymer membrane. The release of progesterone from this system is maintained almost constant for 1 year. The effects of release are local, with none of the systematic side effects observed with orally administered contraceptives [200-207]. 

The oral contraceptive norethisterone (norethindrone, 129) has been shown to produce the 4/ ,5/ -epoxide (130) over a 30 min irradiation at 300 nm in aqueous buffer at pH 7.4. The possibility that this reactive species is responsible for the non-dermatological side-effects of oral contraceptives containing norethisterone was noted. One serious systemic effect of the drug which could be caused... 

Sustained-release formulations can produce stable serum concentrations with once or twice daily dosage. Therapeutic effects occur at blood levels > 5 mg/1, and side effects increase considerably at levels > 15 mg/1. Smoking, alcohol, anticonvulsants, and rifampicin induce the drug-metabolizing enzyme system in liver and reduce the half-life of theophylline. On the other hand, heart and liver failure, sustained fever, old age and drugs such as cimeti-dine, ciprofloxacin, and oral contraceptives reduce theophylline clearance and thereby increase serum concentrations. 

A low dosage of progestin ( mini-pill ) is used, in the form of medroxyprogesterone acetate, which is active at a very low dose. The mini-pill does not inhibit ovulation, but rather interferes with the endometrium and the cervical mucus. The use of this pill prevents most of the side effects of oral contraception, specifically nausea, water retention, and in some cases thrombophlebitis. However, a lower success rate and other frequent side effects have reduced the widespread acceptance of this preparation. Nevertheless, the mini-pill has a role to play in certain specific situations. For example, in an uncommon form of epilepsy called catamenial epilepsy, female patients will experience seizures at particular times during their menstrual cycle, reflecting the fact that seizure focus is stimulated by estrogens but inhibited by progestins. In such women, the mini-pill may afford not only birth control but also improved seizure control. 

Goldzieher JW, Moses LE, Averkin E, Scheel C, Taber BZ. A placebo-controlled double-blind crossover investigation of the side effects attributed to oral contraceptives. Fertil Steril 1971 22(9) 609-23. 

Loder EW, Buse DC, Golub JR. Headache as a side effect of combination estrogen-progestin oral contraceptives a systematic review. Am J Obstet Gynecol 2005 193 636-49. 

In conclusion, contraception therapies with vaginal rings present excellent efficacy with little risk of side effects and appear to be as effective as oral contraception and IUD, in terms of pregnancy prevention [42]. Moreover, rings are characterized by important benefits like ease of use, long-term schedule, and user-controlled application. These versatile drug delivery systems appear to be safe, effective, and acceptable. 

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