Oral contraceptives anemia

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. 

Cytochrome P450 inducer (oral contraceptive failure) Autoinduction Rare blood cell dyscrasias aplastic anemia, agranulocytosis Hepatotoxicity Rash risk, including Stevens-Johnson syndrome Risk for SIADH Teratogenicity risk neural tube defects, craniofacial defects... 

Both sequential and non-sequential types of oral contraceptives impair the absorption of polyglutamic folate but not that of monoglutamic folate the change can result in megaloblastic anemia in predisposed subjects, for example those with celiac disease or having a deficient diet (182). 

Kornberg A, Segal R, Theitler J, Yona R, Kaufman S. Folic acid deficiency, megaloblastic anemia and peripheral polyneuropathy due to oral contraceptives. Isr J Med Sci 1989 25(3) 142-5. 

Folic acid deficiency can be caused by drugs that interfere with folate absorption or metabolism. Phenytoin, some other anticonvulsants, oral contraceptives, and isoniazid can cause folic acid deficiency by interfering with folic acid absorption. Other drugs such as methotrexate and, to a lesser extent, trimethoprim and pyrimethamine, inhibit dihydrofolate reductase and may result in a deficiency of folate cofactors and ultimately in megaloblastic anemia. 

Iron status is improved in most oral contraceptive users because of reduced menstrual blood loss an important benefit of oral contraceptive use is therefore a reduction in the prevalence of iron deficiency anemia (187). Much of the relevant research has been with higher dosages than are currently used. However, a study of a low-dose... 

Contraindications Large doses can decrease the effect of oral anticoagulants oral contraceptives can decrease C concentration in the body smoking decreases serum levels of C. Use with caution in renal calculi (kidney stones) gout, anemia, sickle cell, sideroblastic, and thalassemia. 

Copper Neutropenia, leukopenia, hypochromic anemia, osteoporosis, hair and skin depigmentation, dermatitis, anorexia, diarrhea, mental deterioration, hypercholesterolemia Wilson s disease liver cirrhosis, diarrhea, vomiting, metallic taste Decreased high iron or vitamin C intake, corticosteroid use Increased infection, rheumatoid arthritis, pregnancy, oral contraceptives, decreased biliary excretion... 

FOLATE DEFICIENCY Folate deficiency is a common complication of diseases of the small intestine, which interfere with the absorption of dietary folate and the recirculation of folate through the enterohepatic cycle. In acute or chronic alcohohsm, daily intake of dietary folate may be severely restricted, and the enterohepatic cycle of the vitamin may be impaired by toxic effects of alcohol on hepatic parenchymal cells this is the most common cause of folate-deficient megaloblastic erythropoiesis. However, it also is the most amenable to therapy, inasmuch as the reinstitution of a normal diet is sufficient to overcome the effect of alcohol. Disease states characterized by a high rate of cell turnover, such as hemolytic anemias, also may be complicated by folate deficiency. Additionally, drugs that inhibit dihydrofolate reductase (e.g., methotrexate and trimethoprim) or that interfere with the absorption and storage of folate in tissues (e.g., certain anticonvulsants and oral contraceptives) can lower the concentration of folate in plasma and may cause a megaloblastic anemia. 

Oral contraceptives have major benefits related to menstruation, including more regular menstruation, reduced menstrual blood loss and less iron-deficiency anemia, and decreased frequency of dysmenorrhea. There also is a decreased incidence of pelvic inflammatory disease and ectopic pregnancies, and endometriosis may be amehorated. 

Toxicities When these drugs are used alone, hypoglycemia is extremely rare. Thiazolidinediones can cause edema and mild anemia. Pioglitazone and troglitazone appear to induce cytochrome P450 (especially the 3A4 isozyme) and can reduce the serum concentrations of drugs that are metabolized by these enzymes (eg, oral contraceptives, cyclosporine). 

Oral contraceptives decrease the risk for several disorders, including ovarian cancer, endometrial cancer, pelvic inflammatory disease, premenstrual syndrome, toxic shock, fibrocystic breast disease, ovarian cysts, and anemia. In addition to providing birth control for the client, the cHent gets a secondary benefit of decreasing her risk for ovarian cancer. 

Vitamin Bia status in oral contraceptive users has received less attention than that of folate, possibly in part because there have been no reported cases of megaloblastic anemia with evidence of B12 deficiency in OCA-users. All women with apparent folate deficiency anemia in association with use of OCAs (see above) had normal serum B12 levels in those instances in which it was measured. 

R20. Ryser, J. E., Farquet, J. J., and Petite, J., Megaloblastic anemia due to folic acid deficiency in a young woman on oral contraceptives. Acta Haematol. 45, 319- 24 (1971). 

A 26-year-old woman taking a combined oral contraceptive took methyldopa for hypertension as she was planning a pregnancy in the near future. She developed a hemolytic anemia. The methyldopa was withdrawn and the anemia resolved within 6 weeks. 

Nonpregnant women—It has been established that there are many healthy, nonanemic, young women who have negligible amounts of iron stores (the liver, bone marrow, and spleen may contain some unused iron which may be drawn upon to meet physiological requirements). These women have no reserves to meet increased needs due to such events as blood loss, pregnancy, and other stresses. Furthermore, some women who use the contraceptive pill may become depleted of folic acid and, therefore, have increased susceptibility to megaloblastic anemia (hormones present in oral contraceptives reduce the utilization of dietary folic acid). 

Oral contraceptives—Low tissue folate levels and macrocytic anemia have been found in women taking oral contraceptives. So, higher levels of folacin may be indicated under such circumstances. 

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