Oral Contraceptives Pills (OCP) are still the number one birth-control choice for American women. However, the chemicals in oral contraceptives do affect your overall physical health and body systems in addition to your reproductive system. Risks associated with long term use of estrogen intake in any form are significant. Some of serious side effects include the following • Cardiovascular: Heart disease, Hypertension, Myocardial infarction • Endocrine metabolic: Body fluid retention, Breast cancer, Diabetes mellitus, Hypercalcemia • Gastrointestinal: Disorder of gallbladder, Pancreatitis • Hematologic: Venous thromboembolism ( blood clot in legs and else where in body) • Immunologic: Anaphylaxis (allergic reaction to medicine) • Neurologic: Cerebrovascular accident (stroke), Dementia, Impaired cognition • Ophthalmic: Thrombosis of retinal vein (blood clot in eye) • Reproductive: Cervical cancer, Malignant neoplasm of endometrium of corpus uteri, Ovarian cancer • Respiratory: Pulmonary embolism • Other: Breast cancer, Cervical cancer, Malignant neoplasm of endometrium of corpus uteri, Ovarian cancer Effects on liver disease have been under reported in the literature. Usually the liver problem comes to medical attention, when the disease is advanced. It is recommended to review risk and benefit of this form of contraception in detail with physician prior to initiation. Both natural and synthetic estrogens affect the structure and function of the liver in several important ways, including coagulation, production of glucose, lipid metabolism, billiard (bile) functions and binding proteins. Long-term use of estrogen may affect immune system increases the risk of autoimmune disorders including autoimmune liver disease that may result into cirrhosis The risk of Non-Alcoholic Steato-Hepatitis (NASH), commonly known as fatty liver disease, also increases with longstanding use of oral contraceptives. The contraceptive affects glucose homeostasis, resulting in insulin resistance, which is key abnormality causing Fatty Liver Disease/NASH. A change in the body’s metabolism resulting in high triglyceride levels also increases the risk of fatty liver disease. Fatty liver disease, while treatable, requires medical management; left untreated, it can result in cirrhosis of the liver. Other aspects of liver health affected by oral contraceptives include cholestasis, the rapid development or long term interruption in the excretion of bile; cholesterol level; gallstone formation; Budd-Chiari, an occlusion of the hepatic vein; hepatic tumors; and occasionally, even liver cancer (primarily associated with long-term use of oral contraceptives). Women, who have history of cancers (particularly breast cancer) in their family are high risk. Liver tumors such as hepatic adenoma are strongly associated with estrogen intake. Such tumor has the tendency to turn into a cancer. There is some association with focal nodular hyperplasia, another benign tumor. Long-term use of estrogen may increase the growth of cyst and blood vessel tumor such as hemangioma thus increasing the risk of complications. Talk to your physician about the risks and the benefits of oral contraceptive use, particularly over the long term.

Shahid Habib, MD. Liver Institute PLLC 5295 E Knight Drive Tucson AZ 85712 Email: shabib@liverinstitutepllc.org Web: http://www.liverinsstitutepllc.org Phone: 520-382-5972