Oral contraceptive 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. 

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... 

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. 

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. 

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. 

It is not clear how this could have resulted from the treatment, but it might have entailed fluid redistribution in or around an old appendicectomy scar. It may be noted that nerve entrapment is recognized as a possible adverse effect of oral contraceptives in the carpal tunnel syndrome. 

Lipid changes seen with the most widely used combined oral contraceptives comprise an increase in low density lipoprotein and reductions in high density lipoprotein and cholesterol. The third-generation products have these effects to a much smaller extent, leading to claims that they would be less likely to have long-term adverse cardiovascular effects related to atherosclerosis. However, such a claim reflects an all too readily adopted belief that the lipid changes produced by the more traditional combined oral contraceptives are in this respect capable of causing this type of (primarily arterial) cardiovascular disease. This is of itself far from certain. 

Over the years a few reports have suggested a higher incidence of urinary infections in users of oral contraceptives. There has always been some uncertainty as to whether these sporadic reports reflect an adverse effect or simply a different pattern of sexual behavior among major users of these products. Some have found an increased incidence of urinary infections, others have not. The effect of local estrogens has been explored in a pilot study in 30 young women taking oral... 

Since post-treatment amenorrhea of more than 6 months duration was first suggested as an adverse reaction in around 1965, much work has been devoted to delineating the risk and prognosis of menstrual changes after the withdrawal of hormonal contraception. It is now recognized that post-treatment amenorrhea occurs in 0.7-0.8% of women, but this is no different from the background rate of spontaneous secondary amenorrhea. No cause and effect relation between oral contraceptive use and subsequent amenorrhea has been documented. 

Data on the risk of infection with HIV (human immunodeficiency virus) with combined oral contraceptives are sparse some studies suggest an adverse effect and others show no association (270,285). 

Oral contraceptives reduce the clearance of imipramine, probably by reducing hepatic oxidation, and thus increase its half-life. Hydroxylation of amitriptyline is inhibited by contraceptive steroids. The clinical significance is uncertain, but there is at least anecdotal evidence of an increase in antidepressant adverse effects (360). Caution should be exercised when tricyclic antidepressants are used long term in women taking oral contraceptives. 

Kendall AG, Charlow GF. Red cell pyruvate kinase deficiency adverse effect of oral contraceptives. Acta Haematol 1977 57(2) 116-20. 

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