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  • Title: [Veins and contraception].
    Author: Reinharez D, Monsonego J.
    Journal: Contracept Fertil Sex (Paris); 1985 Jan; 13(1 Suppl):131-6. PubMed ID: 12280199.
    Abstract:
    Oral contraceptive (OC) use entails certain modifications in the venous anatomy and metabolism: hyperviscosity of the blood which slows microcirculation; with blood cells particularly affected and estrogens and possibly progestins playing a role, 2) modifications in coagulation factors caused by synthetic estrogens, 3) augmentation in very low density lipoprotein (VLDL) triglycerides and high density lipoprotein (HDL) cholesterol by norsteroid progestins, and 4) proliferation of the venous epithelium and intimal thickening associated with duration of use and of unproven reversibility on termination of OC use. Venous thromboembolism risk appears to be correlated with high doses of ethinyl estradiol (50 mcg or higher); the androgenic progestins with which they are usually combined appear to have more influence on arterial risk. Varicosities induced by exogenous or endogenous hormonal modification is a clinical entity distinct from other varicosities. Estrogens appear to have indirect effects, while progestins have a direct effect acting as myorelaxants on the venous wall. Some women genetically predisposed to venous problems are particularly sensitive to OCs, but in general venous problems are becoming much more rare with the advent of low-dose OCs. Functional venous problems including cramps, feelings of heaviness in the legs, morning edema and others which may appear before the formation of varices should be distinguished from other conditions that could cause the same symptoms. If measures such as elevating the legs, avoiding tight clothing, and appropriate exercise along with use of a phlebotonic do not relieve the symptoms, the OC can be discontinued to see if symptoms disappear. If they disappear and reappear on resumed OC use, a low-dose pill can be substituted. If the problems persist, a different method of contraception should be used. Varicosities occur relatively frequently in OC users and do not contraindicate OC use. They are not pathogenic but may have an undesirable effect on the body image of the OC user. Diffuse varices do not contraindicate OC use under certain conditions. A minipill or a low-dose progestin is always preferable in such cases. If there is a family history of venous disease, some other contraceptive method should be used. A history of venous thrombosis is the only true contraindication to OC use at present. Some phlebologists are less absolute, regarding previous venous thrombosis as a risk factor to be followed carefully rather than as an absolute contraindication, but it appears prudent to avoid OC use in such patients.
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