Oral contraception and regular laboratory screening What we need to know

23.09.2024

Unplanned pregnancy is a globally relevant issue for today's public health, and oral contraception is considered one of the effective ways to control it.

Table of Contents

When the use of combined oral contraceptives was first introduced in 1960, virtually nothing was known about the long-term effects of its action on the female body and the need for routine health monitoring.

If before that, the world and American professional organizations of gynecology and obstetrics (World Health Organization; Royal College of Obstetricians and Gynecologists; Society of Obstetricians and Gynecologists of Canada; American College of Obstetricians and Gynecologists; International Planned Parenthood Federation, the US; Agency for International Development ) denied the need for pelvic organs and general laboratory tests before starting contraception, their views have changed since the mid-1990s based on accumulated experience and research data.

In standard cases, patient history, weight, and blood pressure data may be sufficient to select the correct contraceptive. However, in the presence of any specific medical condition, it is necessary to discuss it with a specialist in order to select an adequate contraceptive.

Despite the benefits of oral contraceptives, evidence from clinical trials increases the risk of developing such diseases as: obesity, cardiovascular diseases, arterial hypertension, breast cancer, hemorrhagic stroke, venous thrombosis and others. Research shows that contraceptives increase oxidative stress. Oral contraceptives affect genomic pathways, estrogen receptors, liver apolipoprotein indicators, as well as lipoprotein formation processes.

The use of contraceptives may not involve any risks, however, in predisposed individuals, it may cause venous thrombosis and deterioration of liver functions.

During oral contraception, as well as any type of hormone therapy, it is necessary to take into account the health status of the woman and such pathologies as:

Arterial hypertension - taking contraceptives against the background of blood pressure control does not pose a great risk. In women with uncontrolled blood pressure, oral contraceptives significantly increase the risk of developing cardiovascular diseases.
Diabetes mellitus - in uncomplicated, controlled cases of diabetes, taking oral contraceptives may not involve great risks, but complications such as: diabetic nephropathy (kidney damage), retinopathy (retinal damage), vasculopathies (blood vessel damage) and others are often contraindications to the appointment of combined contraceptives. .
Tobacco use – in women aged 35 and older who actively use tobacco, any type of hormonal medication, including contraceptives, significantly increases the risk of cardiovascular disease.
Venous thromboembolism - in women who have developed deep vein thromboembolism and stroke in the past, the appointment of combined contraceptives is contraindicated. Progestin-only contraceptives are relatively safe in such cases.
Migraine - combined contraceptives are not recommended for women with migraine with aura. During migraine without aura, in the absence of other risk factors, it is possible to prescribe a monocomponent contraceptive by a specialist.
Breast cancer - In case of current or past breast cancer, the use of oral contraceptives is not recommended.
Liver diseases - in the case of liver and biliary tract diseases, the condition worsens against the background of taking any hormonal drug.
Epilepsy – Certain antiepileptic drugs interact with contraceptives, increasing the risk of side effects and other possible complications.

In order to monitor the mentioned processes, it is recommended to regularly conduct a number of studies during oral contraception:

Blood pressure monitoring
Lipid profile tests
Liver function tests
Determination of serum glycemia
Coagulation profile

Hypertension monitoring

Contraceptive-induced or pregnancy-related hypertension has the same risk factors (age, body mass index, personal and family history of hypertension, hormonal disorders, disorders in the renin-aldosterone-angiotensin system, etc.) and causative mechanisms (cardiovascular changes, etc.). Hormonal components usually cause an increase in blood pressure, which makes it necessary to regularly monitor the pressure during contraception.

Laboratory tests

Control of serum cholesterol

Data from clinical trials are often contradictory, although the effects of oral contraceptives on lipoproteins have been confirmed. Long-term use of estrogens usually affects total cholesterol, triglycerides, and very low lipoprotein (LDL) levels.

General blood test

As before the appointment of contraceptives, it is important to study the general state of blood pressure, to detect possible anemia, inflammatory changes, hematopoietic disorders, coagulation changes.

Bilirubin

Contraceptives often increase the concentration of serum bilirubin, especially in the presence of concomitant diseases: hemolytic anemias, liver diseases, biliary tract obstruction.

alanine aminotransferase (ALT) და Aspartate aminotransferase (AST)

Serum levels may increase during long-term contraception. An increase in indicators is also observed during contraception prescribed against the background of liver diseases.

Gammaglutamyltransferase (GGT)

During contraception, complicated pathologies of the liver and biliary tract may cause a change in its indicator.

Coagulogram

Combined estrogen-progesterin oral contraceptives significantly increase the risk of developing venous thrombosis, myocardial infarction and thrombotic ischemia. It is known that thromboembolic complications are related to the estrogenic component of oral contraceptives, while arterial complications are caused by both estrogenic and progesterone components. According to the conducted research, the effect of ethinyl-estradiol on the process of coagulation and fibrinolysis is dose-dependent.

Combined oral contraceptives increase the concentration of plasma fibrinogen and the activity of coagulation factors, especially factors VII and X. The concentration of the coagulation inhibitor (suppressor) antithrombin III is usually decreased. Platelet activity is increased, which increases aggregation (grouping of platelets). This creates a hypercoagulable state, which in turn activates fibrinolytic activity. Studies have established that coagulation disorders are caused by the estrogenic component of the contraceptive and specific types of progesterone combined with it.

Conditions such as thrombophilia and antiphospholipid syndrome, some autoimmune diseases, may involve some risk when prescribed oral contraceptives. Therefore, before choosing a specific contraceptive, it is necessary for a specialist to consider all possible risk factors.

Genetic thrombophilia

Antiphospholipid syndrome