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hormonal contraceptive

Indications: - prevention of pregnancy Contraindications: - estrogen-containing contraceptives contraindicated in women with migraine with aura due to increased risk of stroke [15] Adverse effects: 1) due to estrogens a) increased risk of thromboembolism a) risk 9-18/100,000/year [5] b) increases risk 14-fold with air-travel [4] c) risk higher for oral contraceptives also containing progestin [10] - risk higher for drospirenone than levonorgestrel (OR=2.4-3.3) [9] d) increased risk of stroke (RR = 1.5-2.2) & myocardial infarction for estrogen-containing contraceptives* [11,15] (RR = 1.3-2.3) (RR for 30-40 ug of ethinyl estradiol) [11] b) increased risk of coronary artery disease a) increased risk of MI with 2nd generation agents [1] b) risk is minimal with 3rd generation agents [1] c) increased risk of stroke d) increased frequency & severity of migraine headaches e) increased risk of hepatic adenoma f) post-pill amenorrhea 2) due to progestins - hair loss 3) other a) nausea/vomiting b) weight gain c) depression d) may increase risk of cervical cancer [2] e) NO increase risk of breast cancer [3] f) may increase risk of urinary incontinence [6] g) accelerates HIV progression [7] h) increased risk of glioma [12] - RR=1.5, RR=3.2 with progestin-only contraceptive [12] i) no increase in mortality; may confer benefit [8] * progestin-only contraceptives an option? [11] Drug interactions: - anticonvulsants carbamezepine, oxcarbazepine, phenytoin & topiramate inactivate many hormonal contraceptives [15] Notes: - estrogen-containing contraceptives increase serum 25-OH vit D 20% [13] - use of newer combination hormonal contraceptives associated 34% reduced risk for ovarian cancer [14]

Specific

ethinyl estradiol/norelgestromin transdermal patch (Ortho Evra,Xulane) ethinyl estradiol/segesterone acetate (Annovera) Lunelle NuvaRing (etonogestrel, ethinyl estradiol) oral contraceptive (OC) progestin-only contraceptive

General

contraceptive

References

  1. Journal Watch 22(3):21-22, 2002 Tanis BC et al Oral contraceptives and the risk of myocardial infarction. N Engl J Med 345:1787, 2001 PMID: 11752354
  2. Journal Watch 22(9):74, 2002 Munoz N et al Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 359:1093, 2002 PMID: 11943256 - Moreno V et al Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 359:1085, 2002 PMID: 11943255
  3. Journal Watch 22(15):120-21, 2002 MarchBanks PA et al Oral contraceptives and the risk of breast cancer. N Engl J Med 346:2025, 2002 PMID: 12087137 - Davidson NE & Helzlsouer KJ Good news about oral contraceptives. N Engl J Med 346:2078, 2002 PMID: 12087145
  4. Prescriber's Letter 11(2):8 2004 Detail-Document#: 200203 (subscription needed) http://www.prescribersletter.com
  5. Prescriber's Letter 12(9): 2005 Ortho Evra and the Risk of Thromboembolism Detail-Document#: 210902 (subscription needed) http://www.prescribersletter.com
  6. Townsend MK et al Oral contraceptive use and incident urinary incontinence in premenopausal women. J Urol 2009 May; 181:2170. PMID: 19296979 - Jackson SL and Fihn SD Exogenous estrogen and urinary incontinence. J Urol 2009 May; 181:1989. PMID: 19286197
  7. Stringer EM et al HIV disease progression by hormonal contraceptive method: Secondary analysis of a randomized trial. AIDS 2009 Jul 17; 23:1377. PMID: 19448528
  8. Hannaford PC et al. Mortality among contraceptive pill users: Cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ 2010 Mar 11; 340:c927. PMID: 20223876 http://dx.doi.org/10.1136/bmj.c927
  9. Jick SS and Hernandez RK Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case- control study using United States claims data BMJ 2011; 342:d2151 PMID: 21511805 http://www.bmj.com/content/342/bmj.d2151 - Parkin L et al Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database BMJ 2011; 342:d2139 PMID: 21511804 http://www.bmj.com/content/342/bmj.d2139 - Dunn N The risk of deep venous thrombosis with oral contraceptives containing drospirenone BMJ 2011; 342:d2519 PMID: 21511807 http://www.bmj.com/content/342/bmj.d2519.extract - FDA Safety Alert: Posted 05/31/2011 Birth Control Pills Containing Drospirenone: Possible Increased Risk of Blood Clots http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257337.htm
  10. Lidegaard O et al Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9 BMJ 2011; 343:d6423 PMID: 22027398 http://www.bmj.com/content/343/bmj.d6423.full - Hannaford PC The progestogen content of combined oral contraceptives and venous thromboembolic risk BMJ 2011; 343:d6592 PMID: 22028481 http://www.bmj.com/content/343/bmj.d6592.extract
  11. Lidegaard O et al Thrombotic Stroke and Myocardial Infarction with Hormonal Contraception N Engl J Med 2012; 366:2257-2266June 14, 2012 PMID: 22693997 http://www.nejm.org/doi/full/10.1056/NEJMoa1111840 - Petitti DB Hormonal Contraceptives and Arterial Thrombosis - Not Risk-free but Safe Enough N Engl J Med 2012; 366:2316-2318June 14, 2012 PMID: 22694003 http://www.nejm.org/doi/full/10.1056/NEJMe1204769
  12. Andersen L et al Hormonal contraceptive use and risk of glioma among younger women a nationwide case-control study. British Journal of Clinical Pharmacology. Jan 2015 PMID: 25345919 http://onlinelibrary.wiley.com/doi/10.1111/bcp.12535/abstract
  13. Harmon QE, Umbach DH, Baird DD Use of Estrogen-Containing Contraception Is Associated With Increased Concentrations of 25-Hydroxy Vitamin D. J Clin Endocrinol Metab 101: Aug, 2016 PMID: 27490916 http://press.endocrine.org/doi/pdf/10.1210/jc.2016-1658
  14. Iversen L, Fielding S, Lidegaard O et al Association between contemporary hormonal contraception and ovarian cancer in women of reproductive age in Denmark: prospective, nationwide cohort study. BMJ 2018;362:k3609 PMID: 30257920 Free full text https://www.bmj.com/content/362/bmj.k3609
  15. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022