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Hepatobiliary complications of oral contraceptives.
J Gen Intern Med. 1992 Mar-Apr; 7(2):199-209.JG

Abstract

Complications secondary to the use of oral contraceptive agents are rare. Hepatobiliary complications, while often dramatic in presentation, occur infrequently. In a patient without predisposing conditions to complications, the benefits achieved with estrogen/progesterone products outweigh the risks. Those conditions that would absolutely and relatively contraindicate the use of oral contraceptives are listed in Table 4. Patients with a past history of liver disease in whom liver function tests have returned to normal may tolerate the introduction of oral contraceptives. They need to be monitored closely for adverse reactions. Patients who have experienced cholestatic jaundice of pregnancy should avoid all contraceptives because of a high risk of disease recurrence. Women whose first-degree relatives have experienced cholestasis of pregnancy or oral contraceptive-induced cholestasis may be at increased risk and should be closely monitored while taking birth-control pills. Women with current or previous benign or malignant hepatic tumors should not take oral contraceptives. Active hepatitis is an absolute contraindication to using birth control pills, although patients with a past history of hepatitis and no evidence of active disease can have a trial of these drugs with close follow-up. A final group of women who should avoid oral contraceptives is those with familial defects of biliary excretion, including the Dubin-Johnson syndrome, Rotor's syndrome, and benign intrahepatic recurrent cholestasis. Dubin-Johnson syndrome is often asymptomatic and may manifest only during pregnancy or during the use of oral contraceptives. The reduction in hepatic excretory function induced by the sex steroids can transform the mild hyperbilirubinemia into frank jaundice. Oral contraceptive agents are the most widely used reversible means of birth control currently available. Fortunately, the complications associated with these drugs are infrequent and may be decreasing due to lower-dose products. Complications still occur, however, and need to be recognized by the general internist as medication-induced problems so the offending drugs can be discontinued and appropriate treatment and follow-up initiated. In addition, patients at risk for the development of complications need to be recognized and advised prior to the introduction of oral contraceptives.

Authors+Show Affiliations

Department of Internal Medicine, University of Alabama School of Medicine, Tuscaloosa 35487-0378.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

1336797

Citation

Lindberg, M C.. "Hepatobiliary Complications of Oral Contraceptives." Journal of General Internal Medicine, vol. 7, no. 2, 1992, pp. 199-209.
Lindberg MC. Hepatobiliary complications of oral contraceptives. J Gen Intern Med. 1992;7(2):199-209.
Lindberg, M. C. (1992). Hepatobiliary complications of oral contraceptives. Journal of General Internal Medicine, 7(2), 199-209.
Lindberg MC. Hepatobiliary Complications of Oral Contraceptives. J Gen Intern Med. 1992 Mar-Apr;7(2):199-209. PubMed PMID: 1336797.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hepatobiliary complications of oral contraceptives. A1 - Lindberg,M C, PY - 1992/3/1/pubmed PY - 1992/3/1/medline PY - 1992/3/1/entrez KW - Adolescents KW - Adolescents, Female KW - Age Factors KW - Alabama KW - Americas KW - Biology KW - Blacks--women KW - Case Histories KW - Cholestasis KW - Contraception KW - Contraceptive Methods--contraindications KW - Contraceptive Methods--side effects KW - Cultural Background KW - Data Collection KW - Demographic Factors KW - Developed Countries KW - Diseases KW - Ethnic Groups KW - Family Planning KW - Hepatic Effects KW - Jaundice KW - Literature Review KW - Neoplasms KW - North America KW - Northern America KW - Oral Contraceptives, Combined--side effects KW - Oral Contraceptives--contraindications KW - Physiology KW - Population KW - Population Characteristics KW - Research Methodology KW - Research Report KW - Signs And Symptoms KW - United States KW - Youth SP - 199 EP - 209 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 7 IS - 2 N2 - Complications secondary to the use of oral contraceptive agents are rare. Hepatobiliary complications, while often dramatic in presentation, occur infrequently. In a patient without predisposing conditions to complications, the benefits achieved with estrogen/progesterone products outweigh the risks. Those conditions that would absolutely and relatively contraindicate the use of oral contraceptives are listed in Table 4. Patients with a past history of liver disease in whom liver function tests have returned to normal may tolerate the introduction of oral contraceptives. They need to be monitored closely for adverse reactions. Patients who have experienced cholestatic jaundice of pregnancy should avoid all contraceptives because of a high risk of disease recurrence. Women whose first-degree relatives have experienced cholestasis of pregnancy or oral contraceptive-induced cholestasis may be at increased risk and should be closely monitored while taking birth-control pills. Women with current or previous benign or malignant hepatic tumors should not take oral contraceptives. Active hepatitis is an absolute contraindication to using birth control pills, although patients with a past history of hepatitis and no evidence of active disease can have a trial of these drugs with close follow-up. A final group of women who should avoid oral contraceptives is those with familial defects of biliary excretion, including the Dubin-Johnson syndrome, Rotor's syndrome, and benign intrahepatic recurrent cholestasis. Dubin-Johnson syndrome is often asymptomatic and may manifest only during pregnancy or during the use of oral contraceptives. The reduction in hepatic excretory function induced by the sex steroids can transform the mild hyperbilirubinemia into frank jaundice. Oral contraceptive agents are the most widely used reversible means of birth control currently available. Fortunately, the complications associated with these drugs are infrequent and may be decreasing due to lower-dose products. Complications still occur, however, and need to be recognized by the general internist as medication-induced problems so the offending drugs can be discontinued and appropriate treatment and follow-up initiated. In addition, patients at risk for the development of complications need to be recognized and advised prior to the introduction of oral contraceptives. SN - 0884-8734 UR - https://www.unboundmedicine.com/medline/citation/1336797/Hepatobiliary_complications_of_oral_contraceptives_ L2 - https://medlineplus.gov/drugreactions.html DB - PRIME DP - Unbound Medicine ER -