A review: adverse effects of oral contraceptives.

A summary of what is currently known about the negative side effects associated with oral contraceptive usage is presented and recommendations for prescribing OCs (oral contraceptives) are made. According to the results of several investigations 2-18% of all women who take OCs develop hypertension. For most of these women the effects are mild; however for some the increase in blood pressure is marked and results in renal damage. Several studies demonstrate that the risk of peripheral venous thrombosis and pulmonary embolism is enhanced for women who use OCs compared to nonusers. The risk is somewhat reduced for those who take low estrogen OCs. Women aged 30-39 who take OCs are 3 times more likely to suffer a myocardial infarction than those who do not use OCs. This risk is markedly increased among OC users who either smoke or suffer from hypertension diabetes or hypercholesterolemia. OC users have a 9.5 times greater risk of thrombolic stroke and a 2.0 times greater risk of hemorrhagic stroke than nonusers. For women over 27 years of age OC usage is associated with the development of benign hepatic adenoma. This risk increases markedly with duration of pill use and is greater for women who take pills containing mestranol compared to those who take pills containing ethinyl estradiol. Occasionally cases of pulmonary hypertension peripheral arterial occlusion mesenteric vascular insufficiency Budd-Chiari syndrome and noninflammatory cholestatic liver injury are reported among OC users. Recommendations are: 1) women with thromboembolic disorders and women over 34 years old who smoke or who are obese or hypertensive should be advised to consider other forms of contraception; 2) prescriptions should be written for a 6 month supply and renewed only after a follow-up visit; 3) women who experience elevated blood pressure readings should be advised to discontinue usage; 4) serum triglyceride and cholesterol should be checked every 6 months; and 5) consider the use of low dose heparin for OC users who are recovering from trauma or surgery or who are confined to bed for long periods of time.