Metabolic and vascular risks of oral contraception

Despite selectivity in prescriptions and changes in formulations the combined oral contraceptive (OC) still carries an increased risk of thromboembolism. The primary reason for this risk is the accumulation of ethinyl estradiol in the liver and its related consequences on the balance between coagulation and fibrinolysis and not on circulating lipoproteins. The consequences are especially formidable for persons with pre-existing arterial or venous wall lesions or hemostatic disorders. Prohibition of OC use to all women suspected of having these aforementioned risks has effectively prevented coronary accidents but has been less effective in preventing stroke or venous thromboembolism. In terms of vascular accidents contraindications to OC use are age of 35 or over smoking hypertension diabetes dyslipidemia cardiac valve disease personal or family history of thrombosis and during OC use a significant increase in weight blood pressure and triglycerides.