Update on problems of oral contraceptives.

Abstract

Combined estrogen-progestogen oral contraceptives are the most effective reversible contraception available. Low doses of estrogen are most often prescribed. The risk of benign or malignant lesions of the breast or cervix is not increased; however annual screening is advised. Elevated thyroxine-binding globulin levels do not indicate thyroid damage. Anovulation may occur but usually reverses spontaneously; clomiphene citrate (Clomid) is usually effective in the few cases in which it persists. Progestogen has an anabolic effect resulting in weight gain. Decreased menstrual blood loss benefits iron metabolism. Risk of thrombosis and thromboembolism is slight but those with venous vascular disease should not be given these drugs. Hypertension may be initiated or aggravated by oral contraception. Previous history of preeclampsia or eclampsia is not a contraindication if blood pressure has returned to normal. Chromosomal damage and limb deformities are rare but a patient who has previously had a damaged child should avoid these drugs. Although oral contraceptives are advised for spacing pregnancies once the family is completed sterilization is to be considered.