[Contraceptives and the liver]

Among the typical complications of oral contraceptive use are intrahepatic cholestasis, occurring in women with a special and probably genetical predisposition only, and a thrombotic diathesis secondary to increased hepatocellular synthesis of coagulation factors, both effects induced by the estrogens. This state of hypercoagulability may lead to thrombosis of the hepatic veins and may thus cause the Budd-Chiari syndrome. A tendency to gallstone formation is explained by a derangement in the synthesis of bile acids and by changes in the permeability of liver cell membranes and of epithelial cells of the gallbladder, an effect again due to the estrogen component of the contraceptives. After long-term use, an increased incidence of benign liver cell adenomas is observed; malignant liver tumors do occur very rarely. A causal relationship with focal nodular hyperplasia, however, is unlikely. Only the typical vascular changes of this entity are probably due to the effects of the contraceptives.