Occlusive vascular diseases in oral contraceptive users. Epidemiology, pathology and mechanisms.

摘要: Despite being an unprecedented departure from normal physiology, the combined oral contraceptive is not only highly effective, but it also has a remarkably good safety record. Concerns over persist, though, particularly with regard to venous thromboembolism (VTE), stroke and myocardial infarction (MI). Epidemiological studies consistently show increase in risk of VTE, results are more contentious arterial diseases. 40 years research, mechanisms behind these adverse effects understood. In this review, we integrate information published epidemiology pathology occlusive vascular diseases their factors identify likely explanations for pathogenesis users. Oral contraceptives induce both prothrombotic fibrinolytic changes haemostatic imbalance haemostasis be important contraceptive-induced VTE. The complexity involved difficulty ascribing clinical significance meant that uncertainty persists. A seriously under-researched area concerns Histologically, endothelial intimal proliferation have been identified women exposed high plasma estrogen concentrations lesions associated thrombotic occlusion. Other structural may result increased permeability, loss tone stasis. With disease risk, epidemiological relating dose joint other factors, suggests use per se does cause disease. It can, nevertheless, synergise very powerfully subclinical damage promote Accordingly, intervene cycle repair which would otherwise remain clinically silent or ultimately progress - in, example, presence cigarette smoking hypertension atherosclerosis. Future work should focus on modification established by rather than supposed factors. Attempts understand occlusion users terms general features VTE reference atherosclerosis limiting, future needs acknowledge such occlusions unique features. Unequivocal identification contribute considerably alleviation fears development even safer formulations.