Fast Five Quiz: Contraception

Michel E. Rivlin, MD; Bradley Schwartz, DO

Disclosures

November 21, 2019

For women experiencing menstrual irregularity, oral contraceptives may make the menstrual cycle more predictable. Also, in the inhibition of ovulation, mittelschmerz (pelvic/lower abdominal pain associated with ovulation) may be reduced or eliminated. Oral contraceptives have also been used to treat iron-deficiency anemia secondary to menorrhagia. Oral contraceptives reduce the risk for several conditions, including benign breast disease and pelvic inflammatory disease. Suppression of ovarian stimulation also reduces functional cysts, and cessation of ovulation may prevent ectopic pregnancies. Oral contraceptives are also noted to lessen the risk for epithelial ovarian and endometrial carcinoma.

Some oral contraceptives, especially those that contain estrogen, can trigger migraine headaches, and some have also been associated with increased risk for high blood pressure. This is believed to be secondary to an estrogen-induced increase in renin substrate in susceptible individuals. The risk is higher in patients with additional risk factors, such as obesity, significant family history of hypertension, or history of smoking. For women with high blood pressure, an alternative progesterone-only method should be recommended.

Oral contraception also increases the risk for blood clots in the legs, as the estrogen component of oral contraceptives has the capability of activating the blood clotting mechanism. Low-estrogen oral contraceptives are associated with a lower risk for thromboembolism. Although use of oral contraceptives is not generally associated with a detectable hypercoagulable state, some women are at greater risk for thromboembolism: those who smoke heavily, have high or abnormal blood lipids, have severe diabetes with damage to the arteries, have consistently elevated blood pressures, or are obese.

Read more about hormonal contraceptives.

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