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Published on: January 17, 2019
Oral contraceptives: an update
1Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Drugs of Today (Barcelona, Spain : 1998)
|September 16, 2003
Summary
Oral contraceptives carry a persistent risk of venous thromboembolism, especially with factor V Leiden. While serious cardiovascular risks are rare, smoking and hypertension increase stroke and myocardial infarction risk in users.
Area of Science:
- Reproductive Health
- Cardiovascular Risk Assessment
- Pharmacovigilance
Background:
- Oral contraceptives (OCs) are widely used by reproductive-aged women globally.
- Cardiovascular risks associated with OCs require ongoing evaluation.
- Understanding OC side effects and compliance is crucial for effective use.
Purpose of the Study:
- To review the cardiovascular risks associated with oral contraceptive use.
- To examine the influence of specific progestins (gestodene, desogestrel) on venous thromboembolism risk.
- To identify factors affecting OC compliance and successful use.
Main Methods:
- Review of recent data on cardiovascular risk in oral contraceptive users.
- Analysis of risk factors for venous thromboembolism, ischemic stroke, hemorrhagic stroke, myocardial infarction, and breast cancer.
- Evaluation of factors influencing oral contraceptive adherence and effectiveness.
Main Results:
- A persistent risk of venous thromboembolism exists for all oral contraceptive users, amplified by hemostatic disorders like factor V Leiden.
- The impact of gestodene and desogestrel on venous thromboembolism risk remains controversial.
- Ischemic stroke and myocardial infarction risks increase significantly with smoking and hypertension, particularly in older users.
- Hemorrhagic stroke risk is not elevated in users without hypertension or smoking.
- A slight increase in breast cancer risk is observed, diminishing approximately 10 years post-cessation.
- Side effects, understanding of instructions, and timing of pill intake significantly impact successful oral contraceptive use.
Conclusions:
- While serious cardiovascular sequelae are uncommon, improved compliance is essential for enhancing oral contraceptive efficacy.
- Risk stratification considering factors like smoking, hypertension, and genetic predisposition is vital for safe oral contraceptive prescribing.
- Further research may clarify the role of specific progestins in venous thromboembolism risk.
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