Letter to the Editor: How to Start a Contraceptive in a Patient With PCOS (1).

Abstract

It is with great interest that we read the detail of the article; however some subjects need to be explained and added to this issue. The author has mentioned breast cancer risk in oral contraceptive (OC) users; furthermore cervical cancer is important as breast cancer. There appears to be an increased risk for developing cervical cancer among women who have taken OCs. A systematic review of 28 studies including more than 12 000 women with cervical cancer found that the risk increased with the increasing duration of oral OC use. The author has written about factor V Leiden prothrombin mutation protein S protein C antithrombin deficiencies and venous thromboembolism (VTE) risk in the OC user; however sickle cell disease is another risk factor. The safety of hormonal contraceptives in women with homozygous sickle cell disease has been controversial. No well-controlled study has assessed whether VTE risk in oral contraception users with sickle cell disease is higher than in other combination OC users. However a small US case-control study found that combined oral contraceptive pill use was associated with a nonsignificantly elevated risk of VTE. The role of hormonal contraception in HIV-positive women has been controversial. Studies in female sex workers suggest that some hormonal contraceptives may increase the risk of HIV acquisition but the effect is not seen in women at low risk for HIV infection. Hormonal contraception does not interfere with antiviral drug effectiveness or disease progression in women taking antiretrovirals. However in those not receiving antiretroviral medication combined oral contraceptive pill use has been associated with accelerated disease progression. The literature is conflicting with regard to a possible role of OCs in predisposing to the development of inflammatory bowel disease (9). Given the uncertainty it is reasonable to continue the OC in women with inflammatory bowel disease who are doing well. OC therapy appears to induce or exacerbate symptoms of hereditary angioedema in some patients. Angioedema precipitated by estrogen in the OC user is mediated by bradykinin. Recurrent urticaria may have been underestimated in this context. (full text)