Pregnancy oral contraceptive effects

Melasma can occur both in pregnanQr and following oral contraceptive administration in a small number of women. After cessation of therapy, the melasma induced by the pill fades more slowly than that accompanying pregnancy [336] and may be permanent. Acne may occasionally improve on oral contraceptive medication [337]. As with pregnancy, oral contraceptive users are more prone to vaginal moniliasis [338]. A similar situation occurs with telangiectasia. Other minor adverse effects are discussed in an excellent review by Jelinek [339]. 

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. 

As an alternative to oral contraceptive pills, which must be taken daily in order to reliably prevent pregnancy, non-oral contraceptives in the form of transdermal, transvaginal, and injectable preparations are available and offer patients safe and effective alternatives to the pills for prevention of pregnancy. These formulations also do not require daily administration, making them more convenient than the pill formulations. 

Women of reproductive potential prescribed efavirenz should be counseled on its potentially teratogenic effects and the importance of birth control. Additionally, nevirapine, nelfinavir, ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir have been shown to decrease the concentrations of estrogens and/or progestins in oral contraceptives, which could lead to failure.2 For patients prescribed these drugs, barrier forms of contraception are preferred to prevent pregnancy. DepoProvera may be... 

Prescribers are advised to consult the package insert of any medication administered concomitantly with hormonal contraceptives, because some medications may decrease the effectiveness of these birth control products. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John s wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding while on oral contraceptives shortly after starting St. John s wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John s wort. 

There is an increased risk of craniofacial defects, spina bifida, and developmental delay in children whose mothers received CBZ while pregnant. Thus, women of childbearing age should avoid this agent. If not practical, contraception should be diligently used to avoid pregnancy. In this context, dose adjustment of oral hormonal drugs may be necessary, since CBZ may accelerate their metabolism and compromise contraceptive effectiveness. 

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. 

Hormone replacement therapy is generally given at a time when pregnancy can be excluded, but in principle some of the risks discussed in connection with oral contraceptives would arise if a women taking hormone replacement therapy were to become pregnant. In 1980, an authoritative Scientific Group of the World Health Organization (WHO) surveyed the entire question of the effects of female sex hormones on fetal development and infant health (200), and after 25 years one can conclude that later reports in the literature have almost entirely supported its conclusions. 

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