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SIDE EFFECTS OF THE COMBINED ORAL CONTRSCEPTIVE PILL

 

When the OCP was first introduced thirty years ago, its high doses of synthetic hormones were far more likely to induce side effects such as nausea, headaches, weight gain, high blood pressure, blood clots, heart attacks and strokes, than today's low dose OCRs. Indeed, the original OCP was more suited to an elephant than a woman! We are still searching for the ideal contraceptive and although today's low-dose OCP& are generally safe and well tolerated, they are not without side effects in all women. Let's explore some possible side effects:

1.         Weight Gain
Some women are definitely susceptible to this, particularly those who are always battling with their weight. OCPs containing the more masculine (androgenic) progestogens, particularly in higher dose pills, may stimulate the appetite and increase the accumulation of body fat. Pills containing a high dose of oestrogen may cause fluid retention which further increases weight. This fluid retention may be associated with an aggravation of varicose veins, leg cramps or aching legs.
2.         Nausea and/or Vomiting
This is similar to the "morning sickness" of pregnancy and is due to the effect of the pill's hormones upon the liver and stomach. Thankfully, it is often temporary. If you have gall bladder disease or gall stones, the OCP often aggravates these problems causing nausea and abdominal pains. The risk of liver tumours (which are very rare) is slightly increased in women who take high dose OCPs for a prolonged period.
3.         Breakthrough Bleeding
This is defined as bleeding while you are taking the OCP and occurs apart from your regular withdrawal bleed. Because it is usually unpredictable, it is a real nuisance but may be prevented by changing to a higher dose pill. It may be a signal that your OCP is not being properly absorbed from your intestines which may occur if you have an intestinal upset or infection or if you are on other medication (e.g. antibiotics, anti-epileptic drugs, or asthma medication). Please check with your doctor if it is occurring as adequate contraception may not be ensured.
4.         Pigmentation of the Skin
The OCP and also pregnancy may induce brown patches of pigmentation, especially on the face, and this is called chloasma or the "mask of pregnancy".
5.         Absence of Menstruation (Amenorrhoea)
One in every hundred women on the combined OCP fails to menstruate after stopping the pill. Such women usually have pre-existing hormonal problems such as the polycystic ovarian syndrome (See Page 97) and their menstrual cycle can be restored with hormonal therapy thus restoring their fertility. The OCP does not exert any long-term negative effects on fertility.
6.         Mood Changes
The effect of the OCP upon a woman's mental and emotional state is variable. Some find that it increases wellbeing and equanimity by preventing hormonal highs and lows, whereas others find it induces depression, irritability and loss of sexual desire. The latter effect probably arises because the pill reduces the amount of the brain chemical serotonin that exerts a balancing effect upon moods, mental drive, appetite and sexual desire. In a minority of women, the OCP induces severe and unpleasant mood changes that necessitate its discontinuation. Thankfully, the mood disorders go quickly after stopping the OCR
7,         Headaches
Headaches, especially of the migrainous type may be aggravated or brought on for the first time by the combined OCP. If severe migraine occurs, especially if associated with visual or neurological disturbance (e.g. blindness, flashing lights, weakness or numbness of body parts, speech disturbance, etc), the OCP must be stopped immediately.
8.         Disorders of the Circulation
The high dose OCPs of the 1960s and early 70s were associated with an increased risk of cardiovascular disorders such as high blood pressure, blood clots, heart attacks and strokes. These risks have been greatly reduced with the use of much lower doses of synthetic hormones in today's modern OCPs and are mainly confined to women over 35 who smoke or have pre-existing cardiovascular risk factors, such as high blood pressure, hardening of the arteries or diabetes.
Modern low dose combined OCPs can be considered safe, but only in 1 'safe women", as they can be dangerous in "dangerous women". Dangerous women are smokers, diabetics, those with high blood pressure, obesity, blood clots, high cholesterol or a previous or family history of heart attacks, angina and strokes.
Smoking is a far greater risk factor for heart disease than the combined OCP. Women over the age of 35 who are on the combined OCP and smoke should either give up the pill or stop smoking. I believe that any woman, who smokes regardless of her age, should not take the combined OCP because of the combined harmful effects of the OCP and smoking upon the blood vessels.
Safe women are those who do not have any of the risk factors characterizing dangerous women and according to the Fertility and Maternal Health Drugs Advisory Committee of the Federal Drug Administration, safe women may continue to take a low dose combined OCP up to any age and, if desired, up until the menopause. Even so, safe women over the age of 40 who take the combined OCP may slightly increase their risk of cardiovascular disease and if this is found unacceptable, the mini pill (POP) is a good alternative.
The synthetic hormones in the pill tend to increase the blood fats, cholesterol and triglycerides, but these increases are usually slight and not outside of normal limits. You can have your blood fats measured before starting and again after six months of taking the OCP to detect any adverse changes.
Ideally, all women should have their blood pressure checked two to three months after starting the OCP to make sure that any increase is not excessive.
Women on the combined OCP who have major surgery are much more likely to get post-operative blood clots. So if you are scheduled for planned surgery you should be taken off the combined OCP four to six weeks prior to the surgery. Emergency surgery should be preceded by drug therapy to prevent blood clots.
Overall, if you have any cardiovascular risk factors, the combined OCP acts to multiply them. The lower the dose of hormones in the OCP, the safer it is and you should work with your doctor to find the lowest dose OCP that works for you.
                                                                                                                              *26\5*

 

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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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