contraceptives--postcoital and Cardiovascular-Diseases

To review new evidence regarding ten controversial issues in the use of contraceptive methods among women with special conditions and to present World Health Organization recommendations derived in part from this evidence.. We searched MEDLINE and PREMEDLINE databases for English-language articles, published between January 1995 and December 2001, for evidence relevant to ten key contraceptive method and condition combinations: combined oral contraceptive (OC) use among women with hypertension or headaches, combined OC use for emergency contraception and adverse events, progestogen-only contraception use among young women and among breast-feeding women, tubal sterilization among young women, hormonal contraception and intrauterine device use among women who are human immunodeficiency virus (HIV) positive, have AIDS, or are at high risk of HIV infection. Search terms included: "contraception," "contraceptives, oral," "progestational hormones," "medroxyprogesterone-17 acetate," "norethindrone," "levonorgestrel," "Norplant," "contraceptives, postcoital," "sterilization, tubal," "intrauterine devices," "hypertension," "stroke," "myocardial infarction," "thrombosis," "headache," "migraine," "adverse effects," "bone mineral density," "breast-feeding," "lactation," "age factors," "regret," and "HIV.". From 205 articles, we identified 33 studies published in peer-reviewed journals that specifically examined risks of contraceptive use among women with pre-existing conditions.. Combined OC users with hypertension appear to be at increased risk of myocardial infarction and stroke relative to users without hypertension. Combined OC users with migraine appear to be at increased risk of stroke relative to nonusers with migraine. The evidence for the other eight method and condition combinations was either insufficient to draw conclusions or identified no excess risk.. Of ten contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly.

Topics: Cardiovascular Diseases; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Evidence-Based Medicine; Female; Headache; HIV Infections; Humans; Hypertension; Lactation; Myocardial Infarction; Progestins; Risk Factors; Stroke

Over the last couple of decades a reduction of estrogen by at least 80% in combined oral contraceptives (OCs) and much research have resulted in effective and safe contraception. We still do not know longterm effects of OCs however. OCs may protect against endometrial and ovarian cancer. A link between current OC use and liver cancer exists in areas where liver cancer is rare. An association between OC use and cervical cancer disappears when researchers control for sexual activity and barrier method use. Some research shows OC use increases the risk of breast cancer, while other research does not. There does appear to be an increased risk of breast cancer developing in women younger than 46 years of age and who have used OCs for at least 10 years. Women who have a preexisting cardiovascular condition and/or smoke should not use OCs. OC progestogens may impair glucose metabolism in healthy women, but just for 6 months. Women with diabetes mellitus can use OCs, but may need to increase insulin intake. OCs can cause hypertension in 4-5% of healthy women and worsen hypertension in about 9-16% of hypertensive women. Progestogen-only OCs have fewer systemic side effects than combined OCs, but often cause menstrual changes. Their long term effects are not yet known. Injectables containing a progestogen cause few, if any, adverse effects. The subdermal implant, Norplant, tends to cause menstrual disturbances, but is safe and effective. Progestogen - only vaginal rings are as effective as progestogen-only OCs, but menstrual irregularities are common. Failure rates for combined vaginal rings match those of combined OCs. Long-term effects of vaginal rings are not known. Postcoital contraception does not cause serious side effects, but may cause vomiting and menstrual irregularities. A levonorgestrel-releasing IUD is effective and reduces menstrual blood loss, sometimes resulting in amenorrhea. Hormonal injections in men are unlikely in the near future.

Topics: Breast Neoplasms; Cardiovascular Diseases; Contraceptive Agents, Male; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Drug Implants; Female; Humans; Male; Progestins; Risk Factors

Hormonal contraceptives will continue to be used for some time to come as the safest means by which to prevent pregnancy. This is the background against which an account is given of the forms of hormonal contraception, their safety, selection of preparations, prescription for young people, side-effects, contra-indication to prescription, and indication for discontinuation.--In the context of side-effects, particular reference is made to the effects of steroids upon fat, carbohydrate, and protein metabolism, the cardiovascular system, and early pregnancy.. A review of the composition and side effects of the various types of hormonal contraceptives (h.c.'s) is presented. The Life Table Method is preferred for determining the efficiency of h.c.s. Combination, sequential, and depot preparations contain both estrogen and gestagen components, and work to inhibit ovulation. Mini-pills consist solely of a low-dosage gestagen, and work to increase the viscosity of the cervical secretions to hinder sperm penetration. "Morning-after pills" can contain either an estrogen or gestagen alone or a combination of both; the relatively high dosages of hormones in these preparations work to inhibit nidation. The use of other medications such as sedatives, anti-epileptic agents, or analgesics can interfere with the effectiveness of h.c.s. H.c. use should be interrupted for 2-3 cycles every 2 years to assure normal ovarial function. H.c. users should have health check-ups every 6 months. H.c.s can be prescribed to adolescents 2 years after menarche if the menstrual periods have been regular fora year. Tables listing various side effects of h.c. use and contraindications for h.c. use are presented. H.c.s can affect the menstrual cycle; the metabolism of lipids, proteins and carbohydrates; and the circulatory system. The effect of h.c. use on the incidence of malignant cervical, endometrial, and breast tumors has not been established. Benign breast tumors develop less frequently among h.c. users, while benign liver tumors are more frequent.

Topics: Cardiovascular Diseases; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Female; Hematologic Diseases; Humans; Metabolic Diseases; Pregnancy

Oral, injectable, and implantable contraceptives offer women safe, effective, and reversible fertility regulation. In some cases, their use also confers important noncontraceptive benefits. By individualizing counseling and recommendations based on relevant behavioral and medical considerations, clinicians can maximize their patients' success with hormonal contraceptives. Even in women with relative contraindications to the use of hormonal contraceptives, the risks associated with pregnancy may be sufficiently great so as to warrant their use.

Topics: Breast Neoplasms; Cardiovascular Diseases; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Liver Neoplasms; Medroxyprogesterone Acetate; Risk Factors; Uterine Cervical Neoplasms

Topics: Breast Neoplasms; Cardiovascular Diseases; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Female; Humans; Liver Neoplasms; Uterine Neoplasms

Topics: Behavior; Breast Diseases; Cardiovascular Diseases; Central Nervous System Diseases; Contraception; Contraceptives, Oral; Contraceptives, Postcoital; Diabetes Mellitus; Female; Headache; Humans; Hypertension; Jaundice; Libido; Liver Diseases; Menstruation Disturbances; Mental Disorders; Nausea; Pain; Progestins; Skin Diseases