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Related Experiment Videos

Oral contraceptives: a reassessment.

R Derman1

  • 1Department of Obstetrics and Gynecology, Cornell Medical Center, New York, New York.

Obstetrical & Gynecological Survey
|September 1, 1989
PubMed
Summary

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Oral contraceptives carry cardiovascular risks, with estrogen linked to venous issues and progestin to arterial problems. Identifying high-risk women and using lower-dose pills can significantly reduce adverse effects.

Area of Science:

  • Cardiology
  • Pharmacology
  • Women's Health

Background:

  • Oral contraceptive (OC) use is associated with cardiovascular risks, categorized by estrogen and progestin components.
  • Estrogen is linked to venous thromboembolism, while progestin is associated with small vessel disease, including myocardial infarction and cerebrovascular accidents.
  • Venous risk may stem from clotting factor changes, and arterial risk from altered glucose and lipid metabolism.

Purpose of the Study:

  • To identify women at highest risk for cardiovascular events associated with oral contraceptive use.
  • To evaluate the effectiveness of risk stratification and dose reduction strategies in mitigating OC-related cardiovascular mortality.

Main Methods:

  • Development of a risk scoring form to screen women for contraindications and elevated cardiovascular risk.
Keywords:
AmericasArterial Occlusive DiseasesArteriosclerosisAtherosclerosisBiologyBreast CancerCancerCarbohydrate Metabolic EffectsCervical CancerCongenital AbnormalitiesContraceptionContraceptive MethodsContraceptive Methods--beneficial effectsDemographic FactorsDeveloped CountriesDiabetes MellitusDiseasesEndometrial CancerFamily PlanningFibroadenosisGlucose Metabolism EffectsHeart DiseasesInfectionsLipid Metabolic EffectsLipidsLiterature ReviewMammary Gland EffectsMaternal MortalityMetabolic EffectsMortalityNeonatal Diseases And AbnormalitiesNeoplasmsNorth AmericaNorthern AmericaOral ContraceptivesOral Contraceptives, Combined--beneficial effectsOral Contraceptives, Low-dose--beneficial effectsOral Contraceptives, Phasic--beneficial effectsOvarian CancerPelvic InfectionsPhysiologyPopulationPopulation DynamicsPregnancy ComplicationsPregnancy, EctopicRisk FactorsUnited StatesVascular Diseases

Related Experiment Videos

  • Exclusion of women with absolute contraindications to oral contraceptive use.
  • Analysis of risk factors including family history of hyperlipidemia, diabetes, hypertension, smoking, and age over 35.

    • Main Results:

    • Women with a history of hyperlipidemia, diabetes, hypertension, or those who smoke over 35 are at greatest risk.
    • Reduced steroid content in oral contraceptives has decreased the incidence of adverse effects.
    • Current knowledge allows for an estimated 86% reduction in oral contraceptive-related mortality.

    Conclusions:

    • Clinicians can significantly reduce oral contraceptive-related mortality by identifying high-risk individuals and utilizing lower-dose formulations.
    • Physicians should transition patients on higher-estrogen formulations (50 micrograms) to lower-dose or multiphasic preparations.
    • Lower-dose and multiphasic oral contraceptives are optimal for both existing users and first-time users to minimize cardiovascular risk.