This page has moved. Click here to view.

COAGULATION DISORDERS

Thrombosis - risk enhanced postpartum

Anticoaogulant

- Fetal malformations

BLEEDING DISORDERS AND WOMEN

ON ANTICOAGULANTS: THERAPEUTIC ADVANTAGES OF OCs

• Ovulation suppression
• Pregnancy prevention
• Decreased menstrual bleeding

Adapted from Cornp, Zacur A JOG 1993:168:1990

RECOMMENDATIONS IN COAGULATION DISORDERS

DYSLIPEDEMIA

Affects - 10% women

TG > 250 mg/dl - no OC

CONTRACEPTION WITH PRESENCE

OF DYSLIPIDEMIA

Treat modifiable risk factors regardless of contraceptive method

Little information on effects of pregnancy: some lipid/lipoprotein altering-drugs ill-advised in pregnancy: MI associated with significant mortality

• Hierarchy of method's ability to potentially affect disease: OC - progestin-only >IUD

Knopp et al A JOB 1993:168:1994

OC USE WITH PRESENCE

OF DYSLIPIDEMIA - (Continued)

• Presence of risk factors and degree of abnormality determine suitability of OC use in affected patients
• If OC used, advisable to minimize lipid/lipoprotein effects via progestin type or dosage
• Re-evaluation 3-6 mo after initiating OCs provides useful information on lipid profile status
• Progestin-only contraception or IUD prudent in overt hypertriglyceridemia

Development of Hypertension in Normotensive Women Starting OCs

Use in asymptomatic MVP patients unless

• Classic migraine or history of

other cerebral events

• Atrial fibrillation or congestive

heart failure

• History of thrombotic event

· Mechanical valves

_ (without anticoagulation)

· Inserted under careful protocol

DIABETES

Need careful control before conception to prevent anomalies

Contraceptive Choices

for Women with Diabetes

• Effective contraception is critical for diabetic women
• No evidence that OCs worsen Type I or

Type II diabetes1

• Young diabetic women free of vascular complications may use OCs containing low-androgenic progestins2
• When vascular disease present, progestin-only3 or intrauterine methods appropriate

I. SkoubyM aL FMM Steni~. 1986;4:858. 2. M~IMI M IL DM/ogu~ kl ~ 2002;4(7}:1.

ENDOCRINOPATHIES

• Thyroid
• Prolactinoma
• PCOS

TREATMENT OF PCOS WITH OCs

SUGGESTIONS

· Estrogenic OCs are most effective

• Less androgenic progestins may provide a better alternative
• Long-term therapy required

 

NEUROLOGIC

Tension Headaches

Migraine Headaches - 18% women

Epilepsy - 1/200 preg.

Rx - Teratogenic

RELATIONSHIPS AMONG MIGRAINE,

STROKE AND OCs

• Walnut Creek Study unable to demonstrate higher frequency of migraine in OC users compared to nonusers*
• No large-scale or cohort studies have been conducted to investigate the risk of stroke in migraineurs on OCs

*Ra,mcharan et al J Report Meal 1980 25.345

OC Use in Women

with Common Migraine

Women with common migraine (no focal neurologic

symptoms)

• May be allowed a trial of OCs
• If migraine intensity or frequency increases while on

OCs, discontinue and consider progestin-only OCs

• Some authorities believe that combination OCs are contraindicated in women with classic migraine (with focal neurologic symptoms)

 

RECOMMENDATIONS FOR CONTRACEPTION IN WOMEN WITH HEADACHE/MIGRAINE

Acceptable contraceptive method

+ If headaches increase in severity and, or frequency.

discontinue use Mattson & Rebar A JOG 168:2027. 1993

HORMONAL EFFECTS OF EPILEPSY

Progestins

4, EEG spikes when given IV in humans 4, seizure frequency in women

Estrogens

1' EEG spikes when given IV in humans 4, seizure threshold to ECT in animals

ECT - Electroconvulsive therapy

TREATMENT OF SEIZURES WITH MPA

Of 11 women with uncontrolled seizures who developed amenorrhea when treated with MPA? 7 reported a reduction in seizure frequency

· Reduction in seizure frequency (N=11): 30% Baselline:8.3 + 5.8seizures/mo

With MPA: 5.1 + 4.1 seizures/too(p=0.02)

Mattson. Neurology 1994:34:1256

OCs AND ANTIEPILEPTIC DRUGS

ANTIBIOTICS AND ANTIFUNGALS

• Efficacy of OCs is notcompromJsed by concomitant antibiotic use (except rifampin-)
• Efficacy of OCs may be compromised by concomitant oral antifungal use

· Counsel pill use compliance; condom backup

• If treating TB with rifampin, discontinue OCs and consider DMPA or IUD use