Our GP is ready to help you if you want to be sure that you are healthy and in good shape, you have medical questions or problems and want to discuss with an experienced doctor, you have some unknown symptoms and want to know what they could be related to, you want to know another medical opinion about the best way of treatment of your disease.
To help obstetrician/gynecologists facilitate contraceptive counseling and selection for women with preexisting medical conditions, the American College of Obstetricians and Gynecologists (ACOG) recently (July 1, 2000) issued a new practice bulletin on hormonal contraception. The document addresses the use of oral contraceptives (OCs), implants and injections in women who have hypertension, diabetes, migraine headaches, fibrocystic breast changes or a history of breast cancer, uterine fibroids or high cholesterol.
OCs are the most common form of reversible birth control used by women of childbearing age (15-44). According to the National Center for Health Statistics 10.4 million US women used the pill, 1.1 million used injections and 515,000 used implants for birth control in 1995. And, because of its other health benefits such as protection against some cancers, the pill remains an attractive method of birth control for many women.
Although numerous studies have addressed the safety and effectiveness of hormonal contraceptive use in healthy women, data are far less complete for women with underlying medical problems or other special circumstances. Decisions regarding OCs for women with these "coexisting" medical problems may be complicated. In some cases, medications taken for certain chronic conditions may alter the effectiveness of hormonal contraceptives. Pregnancy in these cases may pose substantial risks to the woman as well as the fetus.
Also, because researchers' recommendations vary widely, substantial confusion exists among doctors with respect to contraceptive guidelines such as: when to prescribe a combination OC (estrogen and progestin), a progestin-only OC, an implant or injection. The following is a sample of ACOG's recommendations to help clarify appropriate use:
Women with fibroadenoma (benign breast disease) are at little or no additional risk of breast cancer because of OC use. Therefore, OCs can be prescribed for these women if they are otherwise appropriate candidates.
Combination OCs should be prescribed with caution, if ever, to smokers over age 35. Women smokers younger than 30 who are otherwise healthy generally can be prescribed combination OCs.
Women age 35 and younger with well-controlled and monitored hypertension are appropriate candidates for a trial combination OC formulated with 35 ug or less of estrogen, provided they are otherwise healthy, nonsmokers and with no evidence of end organ vascular disease. If blood pressure remains well controlled several months after beginning OCs, use can be continued.
Use of combination OCs by diabetic women should be limited to those who do not smoke, are younger than 35 and are otherwise healthy with no evidence of hypertension, nephropathy, retinopathy or other vascular diseases.
Progestin-only contraceptives may be appropriate for women with coronary artery disease, congestive heart failure, or cerebrovascular disease. However, combination oral contraceptives are not recommended for these women.
Birth control injections or implants are safer alternatives than combination OCs in women with one or more of the following conditions: migraine headaches, lupus, sickle cell anemia, and hypertension or diabetes with vascular disease or older than 35.
In their summary of the bulletin, ACOG stressed that women with any coexisting medical condition or risk factor who use oral contraceptives require close monitoring and follow-up evaluation, and that any birth control decision should be made in conjunction with their ob-gyn. ACOG also notes that other, non-hormonal birth control methods may be safe and effective contraceptive choices for many women with preexisting medical conditions.
Medical online consultation with qualified doctors
Copyright © 2004-2005