EFFECTS OF ORAL CONTRACEPTIVES

This review was limited to topics of current concern with respect to the use of oral contraceptives (OCs). Thromboembolism, liver injury, fertility and infertility, miscellaneous adverse effects (such as headaches and psychological and metabolic effects), and acceptance were the topics covered. It was found that the risk of death due to pulmonary embolism or cerebral thrombosis among users of OCs amounted to 1.5 per 100,000 women aged 20-34 years as against .2 for a comparable group not using drugs; for users 35-44 years old the risk rose to 3.9 per 100,000 compared to .5 for nonusers. The increased risk associated with suppression of lactation by administration of diethylstilbestrol was most striking among women over 25 years of age; in this group the risk was 10-fold greater than that of lactating mothers. 1 report suggested that women with pulmonary hypertension due to congenital heart disease should probably not receive OCs. Contraindications to the use of OCs must now include any history of thromboembolic disease or disorders of the blood-clotting mechanism. There appeared to be a predisposing factor among women who develop jaundice while taking OCs. A remarkable number of such subjects had had idiopathic jaundice of pregnancy. There seems to be little evidence for permanent liver damage but very definite evidence for bile stasis and transient morphological changes. Much more work needs to be done before any adverse effect on fertility is established. In cases where fertility reduction is suspected, it must be demonstrable that fertility prior to the use of OCs was unimpared. Among 20 patients on OCs who had had migraine, the attacks became more intense and their frequency increased for 15 of the 20 patients. Generally speaking, those using the intrauterine device (IUD) were more persistent in accepting the method than those on OCs probably because the IUD may be used more extensively than OCs in underdeveloped countries.