regards about risks associated with...

regards about risks associated with combination oral contraceptive pills (OCPs) may limit their use in women throughout 35 years of age. most numerous concerns are based on earlier studies of oral contraceptive formulations with a higher ethinyl estradiol ease rather than more recent studies of lower dose formulations. Seibert and associates discuss the ne for physicians to address one as well as the other the risks of OCPs and the misconceptions about this form of contraception when counseling women throughout 35 years of age.

While use of OCP increases the risk of venous thromboembolism, the class of risk appears to be the same in women taking formulations that contain 20 to 35 mcg of estrogen The absolute risk of venous thromboembolism is extremely low (one case per 10000 OCP users for year). Oral contraceptive pills also contain progestins, including desogestrel and gestodene. These couple progestins have been associated with an increased risk of venous thromboembolism.

The risk of myocardial infarction may be increased in women using OCP especially if smoking (more than 10 cigarettes for day) or other cardiovascular risk factors are not past nor future The association between OCP use and ischemic misfortune is less clear, although increased risk has been demonstrated in OCP users who have migraines. There is no documentation of an increased risk of breast cancer in women who use OCP the same study found a slightly increased risk of gallstones, although the risk was lower in women athwart 35 years of age than in younger women

The potential benefits of OCP use in women athwart 35 years of age include effective birth regulate reduced risk of ovarian and endometrial cancers, possible reduc risk of colon cancer, improvement of perimenopausal symptoms, improvement of acne, and increased bone mineral density (although improved fracture rates have not at the same time been demonstrated).

Before use of OCP is initiated, a thorough medical history should be obtained and posterity pressure should be measured. If a patient has risk factors for cardiovascular disease or a family history of dyslipidemia, a routine fasting lipid panel is make acceptableed Mild lipid abnormalities do not contraindicate use of OCP unless lipid levels should be closely monitored. Because OCP can increase kin pressure, they should be prescribed with caution in patients with mild hypertension and patients who failure (see accompanying table).

The best OCP to excellent is the one with the lowest effective estrogen dose. Side validitys are most common during the first three month The in the greatest degree frequent adverse effects are abnormal menstrual bleeding, nausea, weight gain, temper changes, breast tenderness, and headache. Follow-up should include annual offspring pressure measurements, lipid profiles in patients with a baseline abnormality, and a review of symptoms that could signify an important adverse import To help patients recall possible adverse meanings they may have experienced, physicians can use the acronym ACHES (abdominal pain, chest pain, headaches, view problems, severe calf or thigh pain). Breakthrough or intermenstrual bleeding is everyday and usually resolves spontaneously after a scarcely any months. The incidence of breakthrough bleeding appears to be higher with formulations containing lower estrogen doses.

The authors judge that OCPs can be prescribed safely for many women throughout 35 years of age. Physicians should explain the risks and benefits of OCP for women in this population and should address misconceptions in such a manner that an informed decision can be made.

Seibert C et al. Prescribing oral contraceptives for women older than 35 years of age. Ann Intern M January 7 2003;138:54-64

COPYRIGHT 2003 American Academy of Family Physicians

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