Review Question - QID 105175

Combined oral contraceptive use has been found to be associated with a reduced risk of ovarian cancer.

Exogenous estrogen used in combined oral contraceptive pills (COCPs) has widespread activity in the body. Side effects include hypercoagulability leading potentially to deep venous thrombi (DVTs) or pulmonary emboli (PEs), worsening of lipid profiles and glycemic control, and increased systolic and diastolic blood pressure. COCPs have protective effects including decreasing the risk of endometrial and ovarian cancer as well as pelvic infections.

Bonnema et al. report: "combined oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes mellitus, depression, and uncomplicated valvular heart disease. Contraceptives containing estrogen, which can increase thrombotic risk, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease. Progestin-only contraceptives are recommended for women with contraindications to estrogen."

Luo et al. write: “Defective contractile motility of the gallbladder is an important factor for gallstone formation. Estrogen might increase the risk of gallstones and cholecystitis, as estradiol inhibits the contractile activity of isolated strips of guinea pig gallbladder.”

Incorrect Answers:
Answer 1: Estrogen-progestin COCPs are associated with an increased risk for VTEs.
Answer 2: Estrogen-containing COCPs can precipitate gallbladder stasis increasing the risk for stone formation or inflammation.
Answer 3: Estrogen-containing COCPs can worsen lipid profiles.
Answer 4: COCPs can worsen blood pressure control, and should be stopped in patients who experience this side effect.