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Estrogen replacement in menopause should be used for specific symptoms such as ovarian failure, hot flushes, vaginal atrophy, atrophy of the vulva, and atrophic urethritis. The dose should be as low as possible to be effective and perscribed for as short as time as possible, since there are possible risks of uterine cancer, breast cancer, increased blood pressure, gallstones, deep vein thrombosis, and thromboembolism. Estrogens should be administered to provide the maximum benefit with the minimum risk involved. Estrogens should not be given to patients with known contraindications such as: suspected breast or uterine cancer; undiagnosed genital bleeding; Dubin-Johnson syndrome; acute hepatic disease; previous or present thromboembolism; or severe thrombophlebitis. Careful evaluation should be made before administering estrogen to women with uterine myomata, hyperlipidemia, hypercholesterolemia, sevare varicose veins, chronic hepatic dysfunction, diabetes mellitus, porphyria, or severe hypertension.
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PMID:Estrogen replacement in the menopause. 39 Apr 56

A case of chorea in a woman taking oral contraceptives, without a previous history of chorea or rheumatic fever, is presented. All laboratory findings were normal except for a considerable increase in triglyceride levels. Complete recovery occurred within 4 months after discontinuing the contraceptive treatment, without any other treatment. It is suggested that the contraceptive steroids may cause some metabolic disorders, which produce secondary vascular disorders. It is emphasized that oral contraceptives should be prescribed only to patients whose anamesis rules out precedents of or predisposition to vascular diseases (thrombophlebitis of the lower limbs, obesity, arterial hypertension, hyperlipidemia, diabetes, tabagism, migraine, or temporary ictus).
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PMID:[Chorea and the use of contraceptives]. 100 33

Cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute fibrinous pericarditis and pericardial effusion. Echocardiography has demonstrated an increased incidence of pericardial effusion, even in those who have minimal symptoms. Chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely. While myocarditis is commonly noted at autopsy, it is often silent clinically. Diagnosis during life can be confirmed only by endomyocardial biopsy. Electrocardiographic changes are often nonspecific. Endocarditis with superimposed nonbacterial verrucous vegetations (Libman-Sacks) is noted in more than 40% of hearts at autopsy, but is rarely diagnosed during life. Valve dysfunctions, such as aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency, occasionally manifest during life and rarely may necessitate surgery. Atrial and ventricular arrhythmias, first degree AV block, and acquired CHB occur in association with pericarditis, myocarditis, vasculitis, and myocardial fibrosis, respectively. CCHB developing in newborns of mothers with SLE, particularly those who have an antibody to soluble tissue ribonuclear protein RO(SS-A), is increasingly being appreciated by both pediatric cardiologists and rheumatologists. Recently, severe coronary atherosclerosis resulting in angina pectoris and/or myocardial infarction in young adults has been noted, particularly in those who had developed risk factors such as hypertension and hyperlipidemia while receiving prolonged corticosteroid therapy. Rarely, coronary arteritis may produce similar symptoms. Congestive heart failure of either single or multiple etiologies carries an ominous prognosis. It remains a cause of high morbidity and mortality unless recognized early and treated properly. Extracardiac vascular manifestations of SLE include telangiectasia, vasculitis, livedo reticularis, Raynaud's phenomena, and thrombophlebitis, all of which may occur either alone or in different combinations. Evidence is now slowly accumulating that substantiates that immune complex deposition, complement activation and subsequent inflammatory reaction is responsible for the majority of the cardiovascular manifestations of SLE, for example, pericarditis, myocarditis, endocarditis, coronary arteritis, coronary atherosclerosis, and systemic and pulmonary vasculitis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cardiovascular manifestations of systemic lupus erythematosus: current perspective. 286 Jun 99

Mechanism of action, indications, side effects and contraindications of oral contraceptive agents (OCA) are reviewed. OCA can be divided into two groups: consecutive and combined agents. Combined OCA contain both estrogens and gestagens and are taken for 3 weeks, while consecutive OCA contain only estrogens and are taken for 2 weeks followed by 1 week of combined OCA until the onset of menstruation. Biological activity of synthetic gestagens is estimated by a dosage which results in a delay of menstruation by 2 weeks. Gestagens norethindrone and norethynodrel were shown to be equally effective, while ethinodiol diacetate and norgestrel were 15-30 times more effective. Estrogen component of OCA is represented by ethinyl estradiol or mestranol. Combined OCA are more effective than consecutive OCA; probability of undesirable pregnancy during administration of combined OCA does not exceed 0.2%. The most frequent side-effects of OCA include nausea, headache, uterine hemorrhage, and changes in libido. OCA can affect the endocrine and reproductive systems. Major endocrine effects of OCA include changes in the cortisol metabolism in the adrenal glands, increase in the level of thyroid-binding globulin in the thyroid gland, changes in the glucose metabolism in the pancreas, inhibition of the luteinizing hormone releasing hormone in the hypothalamus with simultaneous decrease in the production of pituitary gonadotropins and inhibition of the ovulation. The most serious side-effects of OCA include cholelithiasis, thrombophlebitis, thromboembolism, liver adenoma, and myocardial infarction. Absolute contraindications to the use of OCA include hypertension, hyperlipidemia, breast or endometrial cancer, pregnancy, cardio-vascular diseases, liver diseases, and kidney insufficiency.
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PMID:[Principles of the use of oral contraceptive preparations]. 307 80

Studies of blood clotting factors and prospective and retrospective studies on risk of thromboembolism are reviewed until 1969. Clotting factors 7, 8, 9, and 10, coagulation time, and platelet adhesiveness are increased during oral contraception. The significance, however, is unknown for developing thromboembolism. There are numerous publications on thromboemoblism in pill users, but most are statistically useless case reports. Risks of morbidity from this disorder in normal women are 1.2-2.9/1000 for nonpregnant, 3.1-10.4/1000 for postpartum, and .5/1000 for pregnant. A prospective study by the U.S. Food and Drug Administration found no increased risk, but 3 British retrospective studies found a 3-fold risk of phlebits, a 9-fold risk of hospitalization for thrombophlebitis, and an increased risk of death from pulmonary embolism or cerebral accident. Women at greater risk because of age, weight, or predisposing factors (diabetes, hyperlipidemia, surgery) should be meticulously eliminated by the clinician.
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PMID:[Statement on the thromboembolic risk while taking oral contraceptives]. 542 2

Oral contrceptives (OCs), usd by over 30% of reproductive aged women in Belgium, are by far the most widely used contraceptive in that country. The various types of OCs include monophasic, biphasic, and triphasic combinations of an estrogen and a progestin, sequentials containing estrogen only for 7-14 days followed by a progestin through the 21st day; macrodose or microdose progestin only formulations, 3-month injectable progestins, and the morning after pill. Side effects of OCs are mainly due to metabolic effects on coagulation factors, the renin-angiotensin system, glucose tolerance, or the lipid profile. Users of OCs face increased risks of cholelithiases, thrombophlebitis, thromboembolism, cerebrovascular accidents, myocardial infarcts (among smokers over 35 years of age), and hepatic adenomas. The most troubling secondary effect is the excess cardiovascular morbidity and mortality show by contraceptive users, not just those who are obese, hypertensive, or who have histories of vascular pathology, but also those over 40 years of age and smokers. Lenght of use of OCs does not increase vascular risks. Epidemiologic studies demonstrate that vascular risks are reduced in lower dose formulations. Absolute contraindications to OC use include serious cardiovascular problems, severe hepatic pathology, estrogen-dependent tumors, pregnancy and undiagnosed gynecologic problems, and significant hyperlipidemia. Relative contraindications include severe headaches, cholelithiase, previous cholestasis of pregnancy, severe renal disease, fibromyomas, benign breast disease, age over 40 years, smoking, surgery anticipated within 4 weeks, infectious mononucleosis, falciform anemia, and immediate postpartum and lactation. Epilepsy, diabetes, depression, and varicose veins are not strictly speaking contraindications but require additonal surveillance. Lower dose formulations should be prescribed if possible. OC users should be followed up every 6-12 months. Among other steroidal contraceptive methods, sequential OCs and high dose progestin-only formulations are used for short-term treatment of specific conditions. Progestin-only minipills are used when an OC is desired but estrogens are contraindicated. Injectable progestins should be reserved for patients who for cultural or medical reasons can use no other type of contraceptive. Morning-after pills should not be considered a regular form of contraception. If OCs are used in adolescents, a low dose pill is indicated. Low dose OCs may be indicated for diabetics because of the danger of infection with IUDs and the lesser efficacy of barrier methods. If OCs are used in epileptics, they should be regular dosed because of the danger of drug interactions. Only low-dose formulations and progestin-only minipills should be used by women over 40.
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PMID:[The choice of oral contraception in 1984: general indications and specific cases]. 672 93

OC (oral contraception) can cause hypertension in a small minority, about 5%, of users. There does not seem to be a relationship between estrogen dosage and hypertension, while a relationship between progesterone and hypertension seems more possible. Hypertensive reaction to OC has been primarily seen in patients over 30; length of use is another important factor; the incidence after the 5th year of use is reputed to be 2.5-3 times higher than for the first year. Almost all women who develop hypertension with OC use will return to normal levels after OC termination. Several studies indicate a 4-fold to 6-fold increase in the risk of thrombosis and of thrombophlebitis among OC users and especially among woman over 35. OCs containing 50 mcg or less of estrogen can decrease the incidence of thromboembolic diseases by as much as 25%. It has also been reported that OC use before a surgical procedure increases the risk of postsurgical thromboembolism. Frequency of cerebral thrombosis, however rare, also seems to be higher in OC users, especially smokers. Risk of myocardial infarction is also higher among OC users especially in relation to age and smoking. A British study found that mortality rates among smokers were 10.2/100,000 pill users, versus 2.6 in nonusers in the age group 30-39; rates were 62.0 and 15.9 respectively in women over 40; duration of OC use is also a relevant factor. Absolute contraindications to OC use include any precedent of history of cardiovascular or cerebrovascular disease, impaired liver functions, any known or suspected form of neoplasia, genital bleeding, congenital hyperlipidemia, and obviously pregnancy. Relative contraindications include hypertension, migraine, epilepsy, varicose veins, diabetes, uterine leiomyomas, age over 35, and elective surgery. Potential OC users should be carefully screened to minimize possible risks. Age, health history, and smoking are extremely important. Starting OC with a dose lower than 50 mcg of estrogen is also advisable. A woman on OC should be seen every 6 months. Despite side effects and complications, OCs are the most effective and safest method of contraception a physician can offer.
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PMID:Complications and contraindications of oral contraception. 702 10

It is stimulating to ascertain the comparative risk to the woman of hormonal contraceptives of the various kinds used today: combination preparations, which rely on blocking the secretion of gonadotropic hormones by the hypothesis; sequential preparations, which rearrange the physiological relationships of the menstrual cycle; gestagen preparations (minipills), which heighten the viscosity of the cervical mucus; longterm injectable preparations, which initially block ovulation and then act on the cervical mucus; postcoital preparations, which act by inducing abortion of the fertilized egg. Of these the most reliable are the fixed combinations, while sequential preparations are somewhat less so. The minipills are the least reliable. Interaction with other medications can reduce the reliability of these preparations; for instance, women on contraceptives have become pregnant after taking antiepileptic medications containing phenobarbitol and hydantoin. As far as risk is concerned, we must distinguish between those that merely harm the woman and those that pose a threat to life. Some of the former are: bleeding between cycles, failure of menses to appear after cessation of contraception, depression, breast-pains, hypertension, thrombophlebitis, and reduced libido. Hormonal contraceptives also have a series of beneficial effects, especially in women who ordinarily have menstrual difficulties. Among the more serious side effects are: risk of teratogenicity, carcinogenicity, liver problems, thromboses, and infarctions. To reduce the risks of these various side effects, the physician should observe carefully the contraindications: these are both absolute (cerebrovascular and retinal problems, thrombo-embolisms, hepatic disease, diabetes, porphyria, and sickle-cell anemia and relative (migraines, cardiac pains, hyperlipemia, epilepsy, and multiple sclerosis).
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PMID:[Safety and risks of hormonal contraceptives]. 712 52

Deep vein thrombophlebitis (DVT) and pulmonary emboli (PE) have been uncommonly reported manifestations of systemic lupus erythematosus (SLE). This may be partly due to their being masked by other more familiar lesions of the lungs and extremities in SLE. We have identified 17 patients with SLE from a population of 180 being followed up prospectively who had 21 attacks of DVT and/or PE. Of the total of 21 episodes the SLE was considered to be active in 14, inactive in 6, and variable in a patient with recurring phlebitis. The incidence of hyperlipidaemia, smoking history, and use of birth control medication or corticosteroids was not higher in these patients. These clinical findings thus constitute additional features of SLE occurring in about 9% of patients and may be significance for morbidity and mortality.
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PMID:Venous syndromes and pulmonary embolism in systemic lupus erythematosus. 743 59

Biochemical investigations carried out in patients with acute thrombophlebitis of the lower limb superficial veins showed that 70% of such patients develop marked changes in blood plasma lipid spectrum, hyperlipidemia. Blood serum lipid spectrum was examined in 19 patients with various forms of acute thrombophlebitis of the lower limb superficial veins and in 17 with varicose disease. Histologic material for morphologic examination (a fragment of the great subcutaneous vein near saphenofemoral anastomosis and of the wall near the thrombus) was collected during surgery. Venous wall fragments were examined under a light microscope for lipid content. The findings did not confirm the expected changes in venous wall in hyperlipidemia analogous with arterial wall changes in atherosclerosis. That is why we may propose that hyperlipidemia, though not directly changing venous wall structure, contributes to thrombogenesis process via other mechanisms.
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PMID:[The role of hyperlipidemia in the pathogenesis of acute thrombophlebitis of the surface veins of the lower extremities]. 831 10


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