Oral contraceptives withdrawal

A 23-year-old woman developed an acute painful syndrome with cytolysis after 7 years of oral contraceptive use she recovered promptly after oral contraceptive withdrawal (220). 

The answer is b. (Katzungr pp 806—807J Rifampin induces cytochrome P450 enzymes, which causes a significant increase in elimination of drugs, such as oral contraceptives, anticoagulants, ketoconazole, cyclosporine, and chloramphenicol. It also promotes urinary excretion of methadone, which may precipitate withdrawal. 

There is some reason to distinguish this from the ischemia that can be caused by oral contraceptives, in that it is restricted to the colon, can have a chronic or remitting course, can present with non-specific abdominal and colonic symptoms, can be reversible despite continued use of estrogen, and does not require surgical treatment. The symptoms of intestinal ischemia resolve within days to weeks after withdrawal of the estrogen. However, oral contraceptives have also been reported to cause ischemic colitis. 

Suggestive case histories raised at an early phase the notion of a possible correlation of oral contraceptives with endometrial cancer. Among cases of endometrial cancer there seemed to be an excess of users of oral contraceptives, particularly of the early high-dose estrogen type. With the virtual demise of these early products, the situation seems to have reversed a 1983 study from the Centers for Disease Control (CDC) in Atlanta showed that women who had used fixed combinations for oral contraception at some time in their lives had a relative risk of endometrial cancer of only 0.5 compared with never-users (112). The protective effect occurred only in women who had used oral contraception for at least 12 months, and lasted for at least 10 years after withdrawal. The WHO adopted the same view in 1988 in the light of multinational data (113). As in the case of hormonal replacement therapy, the protective effect seems to be due to the progestogen component. 

There is a significant rise in fibrinogen concentrations during the early months of oral contraceptive use, and concentrations return to baseline after withdrawal (73). Prolonged use of oral contraception also seems to lower concentrations of antiaggregatory prostacyclin (74). 

A systematic review of published data on the occurrence of headache with the more modest combination products now used has shown little indication that they have a clinically important effect on headache in most women (142). Headache that occurs during early cycles of oral contraceptive use tends to improve or disappear with continued use. No clear evidence supports the common clinical practice of switching from one oral contraceptive to another in the hope of attaining a lower incidence of headache. However, manipulating the extent or duration of estrogen withdrawal during the cycle may provide benefit. 

Pre-existing condyloma acuminata have been stated to increase during oral contraception, with regression after withdrawal (244). 

In one case, pityriasis lichenoides disappeared after withdrawal of oral contraceptives (245). 

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. 

Drugs nitroglycerine, hydralazine, oral contraceptives, reserpine, theophylline, digitalis, estrogens, ergotamine, corticosteroids, or caffeine withdrawal... 

Sterilization Oral contraceptive Condom Spermicide Withdrawal Diaphragm Periodic abstinence Intrauterine device (IUD) Douche... 

Following use of oral contraceptives, females normally retain fertility, and the normal cycles of menstruation usually start soon after withdrawing the pill. There is evidence both for and against an increased risk of breast cancer. 

The pill should be taken about the same time (to within 12 hours) every day to establish a routined The monthly bleeds that occur 1-2 days after the cessation of active hormone administration are hormone withdrawal bleeds not natural menstruation. They are not an essential feature of oral contraception, but women are accustomed to monthly bleeds and they provide monthly reassurance of the absence of pregnancy. 

Menstruation can be postponed by giving oral norethisterone 5 mg t.d.s., starting 3 days before the expected onset bleeding occurs 2-3 days after withdrawal. Users of the combined oral contraceptive pill (having a 7-day break) can simply continue with active pills where they would normally stop for 7 days. 

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