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  • Title: [Oral contraception: users' questions].
    Author: Prolongeau JF.
    Journal: Soins Gynecol Obstet Pueric Pediatr; 1993 Feb; (141):32-5. PubMed ID: 8278890.
    Abstract:
    Answers are provided to common questions about the safety and use of oral contraceptives (OCs). Amenorrhea during OC use has no pathologic significance. It is related to endometrial atrophy resulting from insufficient estrogen after longterm pill use. A formulation with a higher estrogen content may be used for one or two cycles to regenerate the endometrium. If amenorrhea persists for more than a few months after discontinuation of pills, pituitary adenoma should be ruled out. Bromocriptine may be indicated in cases of moderate hyperprolactinemia if pregnancy is desired. All intermenstrual bleeding in pill users should be investigated for organic cause. Once endometrial polyps and other pathologies are ruled out, the cause may be assumed to be functional metrorrhagia due to endometrial atrophy identical to that causing amenorrhea in OC users. Intermenstrual bleeding may occasionally result from interactions with specific classes of drugs. Minor bleeding in the first cycles of pill use is common and usually temporary. Accidentally taking two pills in one day is without consequence. If the interval between pill cycles exceeds one week, there is risk of follicular maturation and a different contraceptive method should be used until the next cycle. Forgetting a combined pill is without consequence for delays of under twelve hours. Another method should be used until the next cycle if two pills are forgotten. Low-dose oral progestins rapidly lose efficacy if not taken at the same time every day. "Morning-after" pills may be used up to 72 hours after unprotected intercourse. The current generation of OCs entails no teratogenic risks. The cause of any pill failure should be sought. There is no increased risk of multiple pregnancy after discontinuation of pills, and fecundity does not decline after longterm pill use. OCs should be avoided by users of some antiepileptic drugs or of drugs that increase hepatic toxicity or act as enzyme inductors. All conditions accompanied by hepatic insufficiency or cholestasis are formal contraindications to pill use. The effect of OCs on development of vaginal mycoses is unclear. OCs may be an effective treatment for dysmenorrhea because of their antiprostaglandin properties and reduced flow.
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