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Oral contraceptives: a reassessment.
Obstet Gynecol Surv. 1989 Sep; 44(9):662-8.OG

Abstract

Cardiovascular risks attributable to oral contraceptive use may now be subdivided into those that appear to be secondary to the estrogen component, i.e., venous thrombosis, pulmonary embolism, and those linked to the progestin component, i.e., small vessel disease including myocardial infarction and cerebrovascular accident. It appears that venous risk is attributable to subtle changes in clotting factors, while arterial risk may be secondary to changes in glucose and lipid metabolism. In order to determine which women are at greatest risk from oral contraceptive use, Spellacy et al. has developed a risk scoring form that aids in the screening process. After excluding women with an absolute contraindication to pill use, women at greatest risk for cardiovascular disease related to oral contraceptive use are those with a family history of hyperlipidemia, gestational or overt diabetics, hypertensives, and smokers over the age of 35. The gradual reduction by manufacturers of the steroid content of oral contraceptives appears to have lessened the incidence of adverse effects. Our current knowledge of risk factors permits the clinician to reduce exposure to oral contraceptive-related mortality by as much as 86 per cent. As we continue to search for ways to reduce risk among oral contraceptive users, it is important to note that more than 25 per cent of women are still taking formulations containing 50 micrograms of estrogen. It becomes the responsibility of the practicing physician to "step-down" these patients to lower-dose preparations such as the multiphasics. Such preparations also represent optimal therapy for first-time pill users.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Cornell Medical Center, New York, New York.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

2671844

Citation

Derman, R. "Oral Contraceptives: a Reassessment." Obstetrical & Gynecological Survey, vol. 44, no. 9, 1989, pp. 662-8.
Derman R. Oral contraceptives: a reassessment. Obstet Gynecol Surv. 1989;44(9):662-8.
Derman, R. (1989). Oral contraceptives: a reassessment. Obstetrical & Gynecological Survey, 44(9), 662-8.
Derman R. Oral Contraceptives: a Reassessment. Obstet Gynecol Surv. 1989;44(9):662-8. PubMed PMID: 2671844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral contraceptives: a reassessment. A1 - Derman,R, PY - 1989/9/1/pubmed PY - 1989/9/1/medline PY - 1989/9/1/entrez KW - Americas KW - Arterial Occlusive Diseases KW - Arteriosclerosis KW - Atherosclerosis KW - Biology KW - Breast Cancer KW - Cancer KW - Carbohydrate Metabolic Effects KW - Cervical Cancer KW - Congenital Abnormalities KW - Contraception KW - Contraceptive Methods KW - Contraceptive Methods--beneficial effects KW - Demographic Factors KW - Developed Countries KW - Diabetes Mellitus KW - Diseases KW - Endometrial Cancer KW - Family Planning KW - Fibroadenosis KW - Glucose Metabolism Effects KW - Heart Diseases KW - Infections KW - Lipid Metabolic Effects KW - Lipids KW - Literature Review KW - Mammary Gland Effects KW - Maternal Mortality KW - Metabolic Effects KW - Mortality KW - Neonatal Diseases And Abnormalities KW - Neoplasms KW - North America KW - Northern America KW - Oral Contraceptives KW - Oral Contraceptives, Combined--beneficial effects KW - Oral Contraceptives, Low-dose--beneficial effects KW - Oral Contraceptives, Phasic--beneficial effects KW - Ovarian Cancer KW - Pelvic Infections KW - Physiology KW - Population KW - Population Dynamics KW - Pregnancy Complications KW - Pregnancy, Ectopic KW - Risk Factors KW - United States KW - Vascular Diseases SP - 662 EP - 8 JF - Obstetrical & gynecological survey JO - Obstet Gynecol Surv VL - 44 IS - 9 N2 - Cardiovascular risks attributable to oral contraceptive use may now be subdivided into those that appear to be secondary to the estrogen component, i.e., venous thrombosis, pulmonary embolism, and those linked to the progestin component, i.e., small vessel disease including myocardial infarction and cerebrovascular accident. It appears that venous risk is attributable to subtle changes in clotting factors, while arterial risk may be secondary to changes in glucose and lipid metabolism. In order to determine which women are at greatest risk from oral contraceptive use, Spellacy et al. has developed a risk scoring form that aids in the screening process. After excluding women with an absolute contraindication to pill use, women at greatest risk for cardiovascular disease related to oral contraceptive use are those with a family history of hyperlipidemia, gestational or overt diabetics, hypertensives, and smokers over the age of 35. The gradual reduction by manufacturers of the steroid content of oral contraceptives appears to have lessened the incidence of adverse effects. Our current knowledge of risk factors permits the clinician to reduce exposure to oral contraceptive-related mortality by as much as 86 per cent. As we continue to search for ways to reduce risk among oral contraceptive users, it is important to note that more than 25 per cent of women are still taking formulations containing 50 micrograms of estrogen. It becomes the responsibility of the practicing physician to "step-down" these patients to lower-dose preparations such as the multiphasics. Such preparations also represent optimal therapy for first-time pill users. SN - 0029-7828 UR - https://www.unboundmedicine.com/medline/citation/2671844/Oral_contraceptives:_a_reassessment_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=2671844.ui DB - PRIME DP - Unbound Medicine ER -
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