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  • Title: [Hepatic and biliary repercussions of estrogens: dose or duration of treatment effect].
    Author: Hecht Y.
    Journal: Contracept Fertil Sex (Paris); 1991 May; 19(5):403-8. PubMed ID: 12316961.
    Abstract:
    The effects of dose and duration of estrogen treatment on cholestasis, hepatic regeneration, and the genesis of liver tumors are evaluated in this work. Estrogens, especially at high doses during pregnancy or after long use of oral contraceptives (OCs), cause a constant diminution of bile secretion which remains subclinical in the great majority of cases. Ethinyl estradiol causes a constant but reversible cholestasis in the rat. 2 categories of cholestasis related to estrogens are distinguished in clinical practice; cholestasis induced by estrogens in pregnancy or in OCs, and cholestasis aggravated or revealed by estrogens, such as primitive biliary cirrhosis. Cholestasis induced by estrogens is dose-dependent, but few clinical data are available on this point. Experience has shown that a woman predisposed to cholestasis due to condition even with low-dose combined OCs. OCs are contraindicated for women genetically predisposed to cholestasis. Evidence has been found of an interaction between estrogen and DNA in the initiation of regenerative processes after experimental hepatectomy. 2 benign liver tumors, hepatic adenomas and focal nodular hyperplasias, have become more common with widespread diffusion of OCs. The role of estrogens in the genesis of hepatic adenomas is well established, but is more controversial with focul nodular hyperplasia. The appearance of low- dose OCs does not seem to have decreased the incidence of benign liver tumors. On the other hand, 2 series totalling 113 cases have demonstrated that the risk of adenoma increases significantly with the duration of treatment, and another study of 32 cases of focal nodular hyperplasia and 12 adenomas showed that most of the women had used OCs for more than 5 years. Both types of tumor carry risks of hemorrhagic accidents, and adenomas at least also carry carcinoma appears more significant in a country like Great Britain with a very low prevalence of such cancers. Benign liver tumors are very rare and should not affect prescription of OCs. A hepatobiliary sonogram should be obtained for women seeking OCs. A sonographic image of a tumor less than 5 cm in diameter with the characteristics of a benign tumor should prompt termination of OCs and reexamination in 4 weeks. If the tumor is over 5 cm in diameter the diagnosis should be confirmed by another technique. The nodular hyperplasias that are large, painful, and easily accessible. Recent epidemiologic studies suggest that the prevalence of asymptomatic lithiases is not very different in OC users and nonusers, but the frequency of complications leading to cholecystectomy is greater in women receiving longterm estrogen treatment. An asymptomatic lithiasis in a young OC user does not necessarily require termination of OCs.
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