Siti Sarah binti Abdullah

11 -5-077
Side Effects and Complications of COCs
A. Minor
1. Pseudopregnancy manifestations like nausea, vomiting, headache,
mastalgia & weight gain.
2. Menstrual changes : oligomenorrhea & amenorrhea are common but
breakthrough bleeding is more common. 1% may suffer from post pill
amenorrhea.
3. Increased vaginal discharge and monilial vaginitis.
4. Androgenic effects : acne and hirsutism.
5. Psychological changes : mood changes, depression & decreased libido.

B. Major
1. Thromboembolic complications :
It is much increased in pill users due to hypercoagulability of the blood. The
latter is due to increased levels of clotting factors, increased platelets and its
adhesiveness.
2. Metabolic complications :
Manifest diabetes due to its diabetogenic effects.
Atherosclerosis due to disturbed lipid metabolism.
Disturbed liver function tests, cholecystitis and gall stone formation.
3. Teratogenic effects :
Progestogen of combined pills has some androgenic effects. So, its intake in
early pregnancy might cause virilization of the external genitalia of a female
fetus as clitoromegaly and labial fusion.
4. Combined pills and the risk of cancer:
Recent data suggest slight but significant increase in cancer risk of
breast and cervix.
This risk starts to decrease after pill withdrawal and disappeared after
10 years.

On the other hand, combined pills offer some protection against

carcinoma of the ovary, endometrium and colorectal carcinoma.

Non- contraceptive uses of combined pills :

These uses are sometimes indicated but benefits should be weighed against
risks :
1. Better cycle control, reduce heavy menstruation and improve iron
deficiency anemia.
2. Delay menstruation for religious or social reasons.
3. Cycle control before assisted reproduction or ovulation induction.
4. Reduction of spasmodic dysmenorrhea and premenstrual syndrome.
5. Control of functional ovarian cysts and PCOS.
6. Medical treatment of endometriosis in a continuous mode
7. Prevent pregnancy after evacuation of molar pregnancy.
8. During its intake as a contraceptive, it offers a good protection against PID
and ectopic pregnancy.
9. Decrease risk of benign breast tumors, functional ovarian cysts,
endometriosis, endometrial and ovarian cancer.

Drug interaction with combined pills :

Some drugs may interact with COCs or alter their absorption or metabolism
such as :
1. Rifampicin
2. Anticonvulsants
3. Hypnotics, analgesics & sedatives.
4. Mineral oil purgatives
5. Tricyclic antidepressant : compete with COCs on the metabolizing
enzymes which may lead to antidepressant toxic manifestations.