The overall risk of VTE in women taking low-dose combined oral contraceptives buy dianabol are two to three times higher than in non-pregnant women who do not take the combined contraceptives, however, the risk is lower than the risk of VTE in pregnancy and childbirth.
VTE, which manifests itself as a deep vein thrombosis or pulmonary embolism, may occur with the use of any combined oral contraceptive.
Very rarely using COCs thrombosis occurs in other blood vessels, for example, hepatic, mesenteric, renal, and cerebral arteries veins or the retinal vessels. There is no consensus about the connection between the occurrence of these events and the use of combined oral contraceptives available.
The risk of thrombosis (venous and / or arterial) and thromboembolism is increased:
- with age;
- women who smoke; with the number of cigarettes or increasing age the risk increases, especially in women over 35 years old;
In the presence of:
- family history (ie venous or arterial thromboembolism ever in close relatives or parents at a relatively young age). In the case of hereditary or acquired predisposition, the woman should be assessed and the appropriate specialist to resolve the question of the possibility of using combined oral contraceptives;
- obesity (body mass index over 30 kg / m 2 );
- diseases of the heart valves;
- atrial fibrillation;
- prolonged immobilization, major surgery, any surgery to the legs, or major trauma. In these situations, it is desirable to discontinue the use of combined oral contraceptive (in case the intended operation of at least four weeks prior to it) and not to resume reception within two weeks after the immobilization.
The question of the possible role of varicose veins and superficial thrombophlebitis in venous thromboembolism remains controversial. It is necessary to take into account the increased risk of thromboembolism during the postpartum period. Peripheral circulatory disorders also may occur in diabetes mellitus, systemic lupus erythematosus, hemolytic uremic syndrome, chronic inflammatory bowel disease (Crohn’s disease or ulcerative colitis) and sickle cell anemia. Increased frequency and severity of migraine during use of combined oral contraceptives (which may be preceded by a cerebrovascular accident) may be a reason for immediate discontinuation of these drugs. When assessing the status of risks and benefits should be taken into account that adequate treatment of the relevant condition may reduce the associated risk of thrombosis. It should also be borne in mind that the risk of thrombosis and thromboembolism in pregnancy is higher than when taking low-dose oral contraceptives (<0.05 mg ethinylestradiol).
The most important risk factor for cervical cancer is persistent papilloma virus infection.There are reports of some increase in the risk of cervical cancer in buy dianaboluse of combined oral contraceptives.Communication with the reception of combined oral contraceptives has not been proved.Contradictions persist as to the extent to which these findings are associated with screening for cervical abnormalities or with features of sexual behavior (a rare use of barrier methods of contraception).A meta-analysis of 54 epidemiological studies showed that there is a slightly increased relative risk of developing breast cancer diagnosed in women taking combined oral contraceptives currently (relative risk 1, 24).The increased risk disappears gradually within 10 years after discontinuation of these drugs.Due to the fact that breast cancer is rare in women under 40 years, the increase in breast cancer diagnosed in women receiving combined oral contraceptives currently or recently taking is insignificant relative to the total risk of the disease.His connection with the intake of combined oral contraceptives has not been proved.The observed increase in risk may also be due to an earlier diagnosis of breast cancer in women who use combined oral contraceptives.In women, ever use a combined oral contraceptives, the cancer is detected at an earlier stage than in women, never let them apply.In rare cases, against the background of the use of combined oral contraceptives was observed the development of benign and, in extremely rare malignant tumors of the liver, which in some cases led to life-threatening intra-abdominal haemorrhage.In case of severe abdominal pain, liver enlargement or signs of intra-abdominal bleeding it should be considered in the differential diagnosis.
Women with hypertriglyceridemia (or the presence of the state in family history) may increase the risk of developing pancreatitis while taking combined oral contraceptives.
Although a slight increase in blood pressure have been reported in many women taking COCs, clinically relevant increases of this index were rare. However, if while taking combined oral contraceptives develops persistent, clinically significant increase in blood pressure, should be discontinued these drugs and begin treatment of hypertension. Receiving COCs can be continued, if using antihypertensive therapy achieved normal blood pressure values.
The following conditions have been reported to develop or worsen both during pregnancy and when taking combined oral contraceptives, but their relationship with the intake of combined oral contraceptives has not been proven: jaundice and / or pruritus related to cholestasis; the formation of gallstones; porphyria; systemic lupus erythematosus; hemolytic-uremic syndrome; chorea; herpes gestationis; hearing loss associated with otosclerosis. cases of Crohn’s disease and ulcerative colitis during treatment with combined oral contraceptives have also been described.
In women buy dianabol with hereditary forms of angioedema exogenous estrogens may induce or worsen symptoms of angioedema. Acute or chronic disturbances of liver function may require the cancellation of combined oral contraceptives as long as liver function tests have not returned to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of COCs. Although COCs may have an effect on insulin resistance and glucose tolerance, there is no need to change the therapeutic regimen in patients with diabetes mellitus, using low-dose COCs (<0.05 mg ethinylestradiol).
However, women with diabetes should be carefully monitored during the reception of combined oral contraceptives. Sometimes it can develop chloasma, especially in women with a history of chloasma during pregnancy. Women with a tendency to chloasma while taking combined oral contraceptives should avoid prolonged exposure to sunlight and ultraviolet radiation.
Influence of the nature of the bleeding
While taking combined oral contraceptives may experience irregular bleeding (spotting or “breakthrough” bleeding), especially during the first months of use. Therefore, the evaluation of any irregular bleeding should be done only after a period of adaptation of approximately three cycles. If irregular bleeding recur or develop after previous regular cycles, you should conduct a thorough examination to exclude malignancy or pregnancy. Some women during the tablet-free interval may not develop bleeding “cancel”. If combined oral contraceptives are taken according to directions, it is unlikely that the woman is pregnant. Nevertheless, if before that combined oral contraceptives are taken irregularly or if there are no two consecutive buy dianabol withdrawal bleeding, to continue receiving the drug should be excluded pregnancy.