Hormonal contraceptives (Adverse effects)

Hormonal contraceptives are treatments generally based on estrogens and progestins that inhibit ovulation, preventing pregnancy from occurring. One of the most important adverse effects is the presence of venous thrombosis, a risk that increases notably in women carrying certain genetic variants.

Hormonal contraceptives contain progesterone or the combination of progesterone and estrogen. They are available in different formats, including oral contraceptives, skin patches, vaginal ring, implant or injections. Although its main use is as a contraceptive method, it is also indicated in the treatment of premenstrual syndrome, improvement of acne and excess hair, dysmenorrhea and perimenopause, among others.

Its use is widespread and it is estimated that it is used by more than 55 million women.

MECHANISM OF ACTION

Sex hormones, such as estrogens and progesterone, help control a woman's menstrual cycle and fertility. When taken exogenously, they inhibit the release of ovulation-stimulating hormones, causing ovulation not to occur and causing the cervical mucus to thicken, making it difficult for sperm to pass through.

CONTRAINDICATIONS

Hormone-based contraceptives are contraindicated in women with a history of thromboembolism or thrombophlebitis, liver disease, jaundice, hormone-dependent tumors, breast cancer, pregnancy, hyperlipoproteinemia, liver tumors, arterial hypertension or lupus.

In addition, it should be used with caution in patients with migraines, depression, epilepsy, otosclerosis, varicose veins, nephropathy, inflammatory bowel disease or pituitary adenomas. Special caution should also be taken in women smokers.

SIDE EFFECTS

The use of combined hormone therapy may cause side effects such as intermenstrual bleeding, breast tenderness, headache, nausea, abdominal swelling or increased blood pressure. Most of these effects disappear after some time of treatment.

It is important to know that hormonal contraceptives increase the risk of certain serious conditions such as deep vein thrombosis, stroke or liver disorders. The risk of these events is increased by certain factors such as smoking or the presence of certain genetic markers, such as factor V Leiden.

TRADE NAMES

Within the category of hormonal contraceptives, the following active ingredients are found:

• Desogestrel (e.g., Ceracet®, Cyclessa®).
• Estradiol/progesterone (Ex: Metrigen®, Bijuva®)
• Ethinylestradiol/norelgestromin (Ex: Evra®)
• Etonogestrel (Ex: Implanon®, Nuvaring®)
• Levonogestrel (Ex: Mirena®, Liletta®)
• Norethindrone (Ex: Activelle®, Primolut®)