Progestins contraindications

Long-term use of hormone-replacement therapy and concurrent use of progestins appear to contribute to breast cancer risk.7 The use of postmenopausal estrogen-replacement therapy in women with a history of breast cancer generally is considered contraindicated. However, most experts believe that the safety and benefits of low-dose oral contraceptives currently outweigh the potential risks and that changes in the prescribing practice for the use of oral contraceptives are not warranted. Oral contraceptives are known to reduce the risk of ovarian cancer by about 40% and the risk of endometrial cancer by about 60%. 

Some of the contraindications to the use of estrogens, progestins, and estrogen-progestin combinations are presented in Table 61.4. 

Contraindications Carcinoma of breast estrogen-dependent neoplasm history of or active thrombotic disorders, such as cerebral apoplexy, thrombophlebitis, or thromboembolic disorders hypersensitivity to progestins severe hepatic dysfunction undiagnosed abnormal genital bleeding... 

A useful alternative to the pill especially in women in whom estrogen is contraindicated, is Depo-Provera (medroxyptogesterone acetate) which when given i.m. every 3 months is an effective contraceptive. This progestin in large continuous doses Induced an increased incidence of mammary cancer in beagle dogs, an effect not reported in other animals or... 

Progestin-only contraceptives are contraindicated in the presence of undiagnosed vaginal bleeding, benign or malignant liver disease, and known or suspected breast cancer. Depot MPA and levonorgestrel inserts are contraindicated in women with a history or predisposition to thrombophlebitis or thromboembolic disorders. 

In women for whom estrogens are contraindicated or undesirable, progestin-only contraceptives are an option. The progestin-only minipill may have enhanced effectiveness in nursing mothers and women over 40 in whom fertility may be decreased. 

Due to a possible increased risk of vascular disease, combined oral contraceptives should be restricted to women below 35 years without evidence of vascnlar comphcations who have no other risk factors. Progestin-only pills can in most cases be used as in women without diabetes and will therefore often be a good choice for women with contraindications for combined oral contraceptives. 

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