International journal of fertility
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The evidence for and against the association of oral contraceptives (OCs) with vascular disease is reviewed, along with the possible pathophysiologic mechanisms for such an association, including effects on coagulation, circulating lipoproteins, and glucose metabolism. The new, low-dose estrogen OCs appear to affect coagulation minimally, and anticoagulant as well as procoagulant effects have been documented. Such concomitant factors as cigarette smoking, obesity, a family history of thrombosis, lack of physical activity, and blood type influence coagulation more strongly. ⋯ However, educating patients in the management of breakthrough bleeding can help reduce the number of women who must be switched to higher-dose OCs. Epidemiologic evidence confirms the safety of low-dose OCs. By selecting patients carefully, the risk of vascular disease from oral contraception can be reduced to very low levels.
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Review
Results of oral contraceptive epidemiologic studies regarding neoplastic and cardiovascular effects.
Over the past three decades, much of the research on oral contraceptives has focused on cardiovascular and neoplastic effects. Results of recent United States studies have shown no increased risk of death among users of oral contraceptives, although an increased risk of idiopathic venous thromboembolism has been a consistent finding. ⋯ In addition, no clear association has been found between oral contraceptive use and breast cancer or cervical cancer. Data on hepatocellular carcinoma and malignant melanoma are inconclusive.