[Metabolic and vascular risks with oral contraceptives]

Despite selectivity in prescriptions and changes in formulations, combined oral contraceptives still increase the relative risk of thrombo-embolic accidents. The main mechanism implies ethinyloestradiol accumulation in the liver and related consequences, not for circulating lipoproteins, but for coagulation/fibrinolysis balance. Most serious concerns should be directed to subjects having preexisting arterial or venous wall alterations or hemostatic disorders. Restriction of oral contraceptive use extended to all subjects suspected of carrying these risks has been highly effective for prevention of coronary accidents but less for prevention of stroke or venous thrombosis. The crude number of vascular accidents remains very low in women below 35 years old, non smokers, without hypertension, diabetes, dyslipidemia nor cardiac valve disease, without personal or familial history of thrombosis, and without any significant increase in weight, blood pressure and triglycerides while using pills.