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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Health care practitioners are often faced with the dilemma of whether or not to provide oral contraceptives (OCs) to women who have certain chronic medical conditions. Oral contraceptive use among gestational diabetics who use OCs may be at increased risk for developing insulin- dependent diabetes. It appears that progestins are primarily responsible because they decrease the number of insulin receptors on cell membranes. Norgestrel has a more marked effect on carbohydrate metabolism than norethindrone. Estrogen may also play a role by slowing the uptake of glucose. Findings of available studies show that progestin only OCs, combined, low-dose OCs (35 mcg of ethinyl estradiol), or preparations with norethindrone are relatively safe for gestational diabetics. In mitral valve prolapse (MVP) abnormal hemodynamics at the prolapsed valve may promote formation of thrombi and lead to cerebrovascular accidents (CVAs). Oral contraceptives are also known to increase the incidence of thrombi, especially in the lower extremities. A 1986 study of 11 OC users who had had CVAS found that a specific subject of women with MVP are at risk for CVA, perhaps due to persistent clotting abnormalities, however most could safely use a combined, low-dose pill unless headaches, smoking, and MVP symptoms. Oral contraceptive use has usually been avoided in women with sickle cell disease. The major concern has been the possibility of an additive or synergistic effect of OCs on the blood-clotting mechanism. However sickle cell disease is a relative contraindication. Several studies showed that OC use, even up to 54 months, did not increase sickle cell crises, and only 5 cases of thromboses have been reported. The increase of fetal and maternal mortality, however, is a definite risk, therefore a similar low-dose pill may be safe for women with the sickle cell trait.
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PMID:Oral contraceptive use in women with chronic medical conditions. 267 89

Experience with a small dose of d-Norgestrel as an oral contraceptive in 60 patients is reported. 336 cycles were observed. 2 pregnancies occurred, after 1 month and 9 months treatment; in both cases the patients had not taken the medication regularly. Side effects included spotting (50%), menstrual cycle irregularity (40%), headache, increased appetite, venous congestion, and raised blood pressure (1 patient each). 33 patients left the study. Serum FSH and LH levels were studied in 3 patients, vaginal smears in 38 patients, cervical mucus in 10 patients, and endometrial biopsy in 9 patients. Hepatic function was not affected in the 10 patients studied.
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PMID:[Clinical and laboratory evaluation of prolonged administration of microdoses of d-Norgestrel]. 446 47

Minipills contain only 30-40 mgs of ethinyl estradiol, plus Norgestrel or Norethindrone acetate. Administration is the same as for other estroprogestational agents. Minipills are extremely effective and present a few advantages over traditional OC (oral contraception): the risk of thrombotic accidents is decreased, as is the risk of vascular accidents; there is no increase in weight and incidence of headache is much lower. On the other hand breakthrough bleeding is common, as is mastopathy. Patients using the minipill must be closely surveilled; contraindications for minipill use are thrombotic accidents, hyperlipidemia, familial antecedents of hypertension or of vascular affections. The minipill is especially advisable to women over 35.
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PMID:[Advantages, inconveniences, and risks of minipills]. 1226 76