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  • Title: [Metabolic risks of oral contraception].
    Author: Monier L.
    Journal: Rev Int Pediatr; 1988 Feb; (178):64-5. PubMed ID: 12282576.
    Abstract:
    Epidemiological studies clearly indicate that combined oral contraceptives (OCs) increase risks of vascular thromboses. The risk of myocardial infarct is increased by 3 for combined OC users aged 30-39 and by 5 for those aged 40-44. Risks of deep phlebitis and cerebral thromboses are also 5 times greater in OC users. The effects of OCs on serum lipid levels depend on the dose and type of estrogens and progestin. Ethinyl estradiol causes an increase in triglycerides and HDL cholesterol, while progestins tend to increase total cholesterol and decrease HDL cholesterol. Low-dose combined OCs have slight or no effect on cholesterol, HDL cholesterol or triglycerides. Moderately dosed combined OCs elevate triglycerides but their effects on total cholesterol and HDL are moderate. High dose combined OCs increase triglyceride and cholesterol levels. The combined effects of the estrogen and progestin in high dose pills usually increase HDL cholesterol, but there is some doubt as to whether the increase is beneficial. Although all combined OCs have deleterious effects on serum lipids, only persons predisposed to hyperlipidemia are truly at risk. Young women using OCs require systematic control, of serum lipid and lipoprotein levels. Low-dose formulations are generally preferable. Standard or high dosed OCs can cause disturbances of glucose metabolism in predisposed women, but risks of patent diabetes are small. Glucose intolerance developed during pill use is not always reversible. The risk appears more serious with pills containing estranes or norgestrel than with those containing pregnanes. Low-dose pills entail less deterioration than higher dosed pills. Low-dose progestin-only pills also have deleterious effects. OCs interfere with glucose metabolism in part by creating an effect of peripheral insulin resistance and in part by diminishing the insulin-secreting capacities of the islets of Langerhans. All OCs are contraindicated in women with histories of gestational diabetes or glucose intolerance. Insulin-dependent diabetes in adolescents is a relative contraindication. Regular surveillance is required of weight and blood sugar for normal women using OCs. Estrogens have been the major factor identified in variations of coagulation factors and fibrinolysis in OC users. Platelet aggregation has been less well studied. OCs should be avoided in case of hypercoagulative states of platelet hyperaggregation.
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