Thromboembolic Events in Girls and Young Women Taking Hormonal Contraception
Authors:
J. Hyánek; V. Maťoška; L. Dubská; H. Pejznochová; S. Vaingátová; F. Pehal; V. Martiníková; J. Privarová
Authors place of work:
Lipidová ambulance a Oddělení klinické biochemie, hematologie a imunologie, Nemocnice na Homolce, Praha
prim. MUDr. L. Táborský
Published in the journal:
Čes-slov Pediat 2010; 65 (6): 369-383.
Category:
Original Papers
Summary
The authors describe their 15 years of experience in the changes of total cholesterol levels in plasma of girls with familial hypercholesterolemia (FH) during menarche. In half of them, regardless of the findings of LDL-receptors mutations, cholesterol level decreases to normal values and does not require medication. Moreover, the authors describe the negative effect of combined hormonal contraception on cholesterolemia during medication treatment, since combined hormonal contraception increases cholesterol level by 1.5–2.5 nmol/l in almost half of the girls, whereas the effects of the levels of HDL cholesterol and triacylglycerols are not so significant.
The authors selected fatal or life-threatening case reports of pulmonary embolism, thromboembolism, brain events, thromboses and phlebothromboses, which occurred in connection with the findings of hereditary thromboembolic mutations (Leiden mutation FV, Prothrombin II, MTHFR), combined with hyperhomocysteinemia, deficit of holotranscobalamin, high Lp(a) and other external risk factors from the group of patients (adolescent girls and young women up to 30 years of age) who attended the lipid outpatient over the last 5 years. All of these patients took combined hormonal contraception for a short or long period of time without being sufficiently advised or examined by the physician.
In conclusion, the authors strongly require a carefully taken anamnesis and at least basic laboratory examination of APCR before combined hormonal contraception medication. Moreover, they draw attention to astounding lack of knowledge of possible unfavorable consequences of combined hormonal contraception in the adolescent girls themselves and, especially, in their mothers, influenced by positive advertisements only.
The bad experience of the authors indicates that the diagnosis if FH is not taken into account when the combined hormonal contraception is indicated; in the selected sad case reports, thrombophilic anamnesis has never been examined in the family and the physicians have not offered sufficient information about the unfavorable effects of combined hormonal contraception, nor were absolute or relative contraindications considered there.
Key words:
familial hypercholesterolemia – therapy, menarche, hyperhomocysteinemia, combined hormonal contraception – complications, thromboembolism, thromboembolic disease, cerebrovascular accident, thrombosis, phlebothrombosis in adolescent girls
Zdroje
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Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
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