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  • Title: [Hepatic complications of oral contraceptives].
    Author: Saint-marc Girardin MF.
    Journal: Contracept Fertil Sex (Paris); 1984 Jan; 12(1):13-6. PubMed ID: 12312749.
    Abstract:
    By 1977, with 54 million women using oral contraceptives (OCs), various hepatic complications of their use were being suggested. The majority of women suffering complications used high-dose formulations of combination pills, and the low-dose preparations have not been in use long enough for their effects to be known. Subclinical modifications of liver tests were the most common and the least serious effects reported; they disappeared with cessation of treatment, and were in proportion to the strength of the dose. Transaminases and alkaline phosphatases are currently almost always normal. Despite causing a reduction of biliary excretion, OCs seldom provoke jaundice; normal livers have a large reserve excretory capacity. OC related jaundice usually appears within the 1st 6 months of pill use and disappears without sequelae 1 or 2 months after termination of pill use. 50% of women developing jaundice with pill use had experienced intrahepatic cholestasis of pregnancy. OCs are thus contraindicated for women experiencing cholestasis of pregnancy as well as those experiencing any kind of chronic cholestasis. Women taking OCs almost always have elevated cholesterol levels in their bile, which probably explains the increased frequency of cholecystectomies for vesicular lithiase in women taking OCs or estrogens. Anomalies in the composition of bile almost always disappear when OC use is stopped. The role of OCs in the development of hepatic adenomas was discovered through epidemiologic methods. The danger of these benign tumors is related to the risk of a hemoperitoneum or intratumoral bleeding. Pill use should be stopped if such a tumor is discovered, the tumor should be monitored, and surgery may be performed in the case of a large growth. Focal nodular hyperplasias are less dangerous than hepatic adenomas but still necessitate stopping pill use. They have been observed in men and children and were reported in women prior to widespread use of the pill, but OC use appears to favor their growth and the development of complications. Cases of hepatocellular carcinoma in women using pills appear to be due to coincidence. OCs appear very likely to be involved in the development of subhepatic vein thrombosis or the Budd-Chiari syndrome, due primarily to their estrogen content. Pill use should be stopped if these conditions arise.
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