The formulation of oral contraceptives: does the amount of estrogen make any clinical difference?
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Since introduction of oral contraceptive steroids a variety of physiologic-adaptive and toxic side effects have been reported. -a review is given. The study reports also four cases of hepatic vein thrombosis (Budd-Chiari-Syndrome--Venoocclusive disease) and three cases of benign hepatic tumors (liver cell adenoma and focal nodular hyperplasia) in young women following 2- to 5-year treatment with oral contraceptive steroids.
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Oral contraception was introduced twenty years ago and is today the most popular method of preventing pregnancy. Some undesirable side effects of these drugs are well known, while others are only suspected. Many investigations have been undertaken to elucidate whether or not the Pill has carcinogenic properties, and the present study describes the current state of knowledge on this question. At present no evidence exists to suggest that oral contraceptives have carcinogenic effects on the human breast or genital organs. A casual relationship between use of these drugs and development of liver tumors is possible but far from proven.
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Four patients with oral contraceptive associated hepatic adenoma have been studied and the literature reviewed. Clinically, these patients can be divided into ruptured and nonruptured hepatoma groups. In instances of ruptured hepatomas, resection only sufficient to control hemorrhage definitely is recommended. In instances of nonruptured hepatomas, major resection should only be attempted by skilled surgeons, and small multiple lesions should be observed. These management principles will deserve re-evaluation as more experience with these tumors accumulates. Until then, a conservative approach is indicated. This includes the avoidance of oral contraception until the biochemistry of these tumors is better clarified.
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