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  • Title: Increased capillary permeability for plasma proteins in oral contraceptive users.
    Author: Tollan A, Kvenild K, Strand H, Oian P, Maltau JM.
    Journal: Contraception; 1992 May; 45(5):473-81. PubMed ID: 1385569.
    Abstract:
    The transcapillary fluid balance was examined in eleven women before administration of a monophasic oral contraceptive (desogestrel 0.15 mg, ethinylestradiol 0.03 mg), and after three and six months of use. The interstitial colloid osmotic pressure was measured by the "wick" method, and the interstitial hydrostatic pressure by the "wick-in-needle" method in subcutaneous tissue on thorax and leg. During the six-month observation period, the following changes were observed: Plasma colloid osmotic pressure decreased (mean 1.8 mmHg, p = 0.047), as well as serum albumin (mean 5.1 g/l, p = 0.0006), total protein concentration (mean 2.8 g/l, p = 0.0006), hemoglobin (mean 0.5 g/dl, p = 0.014) and hematocrit (mean 1.8%, p = 0.047). Blood pressure and body weight remained unchanged, but foot volume showed a significant increase. The colloid osmotic pressure gradient (plasma-interstitium) was significantly reduced. The results indicate an increase in plasma volume in addition to an increased capillary permeability to plasma proteins during oral contraceptive use. We suggest that the observed changes in transcapillary fluid balance is caused by the estrogen component of the oral contraceptive pill. Physicians at the University of Tromso in Norway enrolled 11 18-26 year old women in a study to determine the effects of 3 and 6 month low dose oral contraceptives (OC) use on transcapillary fluid dynamics. They measured interstitial fluid colloid osmotic pressure (COPi) of the subcutaneous tissue of the thorax and leg with the wick in needle method. A significant fall in hemoglobin (mean 0.7 g/dl) occurred between 0-3 months of OC use (p=.013) as well as in hematocrit (mean 2.3%, p=.044), serum albumin concentration (mean 4.5g/dl, p=.0028), and serum protein concentration (mean 3.2 g/dl, p=.0083). In addition, foot volume rose on average 92.5 ml (p=.002), but body weight and blood pressure stayed the same. Plasma colloid osmotic pressure (COPp) fell slightly (mean 1.1 mm Hg, p=.08). The COPi and interstitial fluid hydrostatic pressure (Pi) on the thorax and the leg did not change. No further changes in hemoglobin, hematocrit, serum albumin, serum protein concentration, COPp, and foot volume occurred during the last 3 months. During the entire 6 months, the transcapillary colloid osmotic pressure gradient on the leg fell on average 2.7 mm Hg (p=.004). It also fell on the thorax (mean 2 mm Hg) but the decrease was not significant. Between 3-6 months, a significant negative relationship between the change in foot volume and the COPi on the thorax occurred as was the change in serum protein (p=.0021). In fact, the change in serum protein was also negatively correlated with the COPi on the leg (p=.0127). Further the change in serum albumin between 3-6 months was positively correlated with the COPi on the leg (p=.0018). In addition, changes in serum protein were positively associated with the COPp (p=.0465). The researchers believed that the estrogen in the low dose OC induced the changes in transcapillary fluid balance.
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