Because estrogens increase HDL cholesterol, the net effect of an oral contraceptive depends on a balance achieved between doses of estrogen and progestogen and the nature and absolute amount of progestogen used in the contraceptive . New acceptors of oral contraceptive agents should be started on a product containing the lowest content of hormone that provides satisfactory results in the individual. 8 in another study in Britain, the risk of developing cerebrovascular disease persisted for at least 6 years after discontinuation of oral contraceptives, although excess risk was very low. 34 however, two studies were conducted with formulations of oral contraceptives containing 50 micrograms or more of estrogen. The study concluded that, with the exception of users of oral contraceptives 35 years and older who smoke and 40 and older who do not smoke, the mortality associated with all methods of birth control is low and less than that associated childbirth. 35 However, current clinical practice involves the use of estrogen formulations combined with careful restriction of oral contraceptive use to women who do not have the various risk factors listed in this labeling. Because of these changes in practice and also due to some limited new data which suggest that the risk of cardiovascular disease with the use of oral contraceptives may now be lower than previously observed, 100, 101 of the Advisory Committee fertility and maternal health drugs was asked to examine the issue in 1989. therefore, the Committee recommended that the benefits of low-dose oral contraceptive use by women in good health non-smokers over 40 are the outweigh the possible risks.
Of course, older women, like all women who take oral contraceptives, should take the wording of the lowest possible dose that is effective and meets the needs of each patient. Numerous epidemiological studies have been conducted on the incidence of breast, endometrial, ovarian and cervical cancer in women using oral contraceptives. The risk does not increase with duration of use, and no relationship was found with dose or type of steroid. Breast cancers diagnosed in current or previous users of oral contraceptives tend to be less advanced clinically than non-users.
Women who currently have or had breast cancer should not use oral contraceptives because breast cancer is a hormone-sensitive tumor. Some studies suggest that the combination oral contraceptive use was associated with an increased risk of cervical intraepithelial neoplasia in some populations of women. 45-48 However, there continues to be controversy about the extent to which these findings may be due to differences in sexual behavior and other factors. 49 rupture rare, benign, hepatic adenomas may cause death through intra-abdominal hemorrhage. There was thrombosis clinical case reports of retinal associated with the use of oral contraceptives. Extensive epidemiological studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy.
55-57 Studies also do not suggest a teratogenic effect, particularly insofar regarding cardiac anomalies and limb reduction defects, 55, 56, 58, 59 when oral contraceptives are taken inadvertently during early pregnancy. If the patient did not comply with the schedule, the possibility of pregnancy should be considered at the first missed period. 60, 61 More recent studies, however, have shown that the relative risk of developing gallbladder disease among oral contraceptive users may be minimal. 62-64 the minimal risk of recent findings may be related to the use of oral contraceptive formulations containing lower hormonal doses of estrogens and progestins. It has been shown that oral contraceptives cause a decrease in glucose tolerance in a significant percentage of users.
17 oral contraceptives containing more than 75 micrograms of estrogen cause hyperinsulinism, while lower doses of estrogen cause less glucose intolerance. 65 progestins increase insulin secretion and create insulin resistance, this effect varying with different progestational agents. 17, 66 However, the non-diabetic woman, oral contraceptives appear to have no effect on fasting blood glucose. 67 Because of these demonstrated effects, prediabetic and diabetic women should be carefully monitored while taking oral contraceptives.
En attendant bébé – les signes de grossesse : suis-je enceinte ou pas ?