Liver diseases related to oral contraceptives.

Abstract

Any of the parenchymal and mesenchymal constituents of the liver can be adversely affected by oral contraceptive (OC) use. Included among these adverse effects are intrahepatic cholestasis hepatocellular necrosis liver cell adenoma focal nodular hyperplasia hepatocellular carcinoma hepatic angiosarcoma sinusoidal dilatation focal hemorrhagic necrosis hepatic vein thrombosis and portal vein thrombosis. It is important to note however that most of these OC-liver disease associations were recorded during a period when OCs had far higher estrogen content than presently prescribed formulations. It is also important to stress that the direct effects on the liver of combined OCs are generally of little clinical consequence. It is the coincidence of OC use with an underlying possibly latent liver or vascular disease that poses serious dangers. A major concern has been the increased risk of hepatocellular carcinoma in longterm (over 8 years) OC users; however animal studies suggest that OC steroids do not cause hepatocellular carcinoma on their own but rather act as promoters and stimulate the growth of already transformed hepatocytes. Due to the extreme rarity of the underlying liver and vascular diseases that seem to promote adverse hepatic effects in OC users it may not even be justifiable to screen for them before prescribing OCs.