Contraceptive pill: when is it a health problem ?

Combination of estrogen and progestogen increases risk of thrombosis and stroke. "The contraceptive pill is the most studied medicine in the world," says gynecologist Hugo Miyahira of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo). This is because it is used by millions of women for years and affects all organs with hormone receptors. Its use prevents not only pregnancy but also ensures a regular menstrual cycle. The evolution of the method has reached its highest point with the combination of two hormones, estrogen and progestogen (the combined pill), at very low levels and more effective than ever, but, like any medicine, it has side effects. Therefore, life habits, health conditions and family history of diseases are determinant in the adoption or not of the pill. If not, other methods can be used without risk to female health. Smoking: "The association of the pill with the cigarette, especially by women over 35, raises - and a lot - the risk of cardiovascular diseases," explains the gynecologist Hugo Miyahira. Several studies show that cigarette substances affect several functions of the arterial vascular system, even when the smoke is no longer in the air. This is because these substances continue circulating in the body, favoring the accumulation of fat and cholesterol plaques in the arteries, a problem known as atherosclerosis. Add that to the fact that the combined pill favors blood clotting and the result can be disastrous, leading to a stroke, infarction, or thrombosis. Hypertension: Hypertension usually presents symptoms only at a very advanced stage and therefore it is essential to measure a woman's blood pressure before recommending the use of a contraceptive pill. According to gynecologist and obstetrician Pedro Awada, of the Hospital and Maternidade Brasil, hypertensive women already present high risk of cardiovascular diseases. This is because the heart becomes hypertrophied due to the great effort to pump the blood in the arteries and, over time, the arteries lose their elasticity, favoring the clogging and rupture of the arteries. Along with the pill, the likelihood of suffering a stroke or other problems connected to blood vessels, such as thrombosis, is much greater. Thrombosis: Thrombosis is caused by three major factors: blood vessel damage, propensity to form clots, and decreased circulation velocity. "As the pill promotes clot formation, its use is prohibited for women who have already suffered the problem or have a family history of thrombosis," explains gynecologist and obstetrician Barbara Murayama, director of the Gergin clinic in São Paulo. The thrombus usually forms in a vein located in the legs, but it can detach itself and rise to the lungs, causing pulmonary embolism, putting the woman's life at risk.Lupus: "Lupus is an extremely complex autoimmune disease that affects even blood vessels," says gynecologist Hugo. In addition, the disease may also be related to antibodies that favor blood clotting and, therefore, thrombus formation. The association with the combined pill increases the risk of stroke, infarction and thrombosis, and is therefore contraindicated for Lupus patients. Obesity: The woman with obesity is at greater risk of suffering cardiac events and, in general, is still a victim of problems such as high cholesterol and hypertension, points out the gynecologist Hugo. According to the expert, excess adipose tissue produces more than 15 substances that interfere with the functioning of the body as a whole, including hormone levels. Thus, the case needs to be well evaluated to determine the cost benefit of using this contraceptive method. In some cases, only the exclusion of estrogen, which exerts greater influence on coagulation, can be effective. Liver disease: "Any medicine used orally is metabolized in the liver," explains gynecologist Barbara. Therefore, if the person has liver damage, such as hepatitis and cirrhosis, the use of the pill may be contraindicated for overloading the organ. In addition, even with the use of the contraceptive it is possible that menstrual irregularities happen. "The unmetabolized hormone does not inhibit the production of hormones by the ovary, which does not diminish the effectiveness of the drug, but can deregulate the hormonal levels of the body," adds gynecologist Hugo.

Hormone-dependent tumors: Some cancers, such as breast cancer, have hormone receptors. In other words, they are hormone-sensitive and may have their development stimulated by hormone levels in the body. "This means that indicating the use of a pill may aggravate the situation of the tumor," explains the gynecologist Pedro. Because tumors usually present only at an advanced stage, preventive screening is critical to not letting the problem worsen. Varicose veins: "Varicose veins already report a woman with blood circulation problems," warns gynecologist Barbara. Dilated and deformed, the veins indicate that the blood is not able to follow its normal course, thus favoring the formation of clots. During the consultation, therefore, it should be evaluated whether the problem is isolated or whether it is still associated with other risk factors for cardiovascular problems, such as obesity. Therefore, the use of the combined pill is not always safe. Factor V of Leiden: "Leiden's Factor V is a genetic mutation that can increase the risk of a woman experiencing a cardiovascular event by up to 100%," explains gynecologist Barbara. The variation directly interferes with blood clotting and can be identified by laboratories in one more step of the pap smear test. According to the specialist, the action of Factor V of Leiden occurs next to the platelets, which can agglutinate and form a thrombus. Once the problem has been identified, other contraceptive methods should be considered. Source: LAURA TAVARES.