Oral contraceptives have been used for many years and a number of adverse effects have been recognized (e.g., jaundice, deep vein thrombosis, thromboembilic disease, gallbladder disease, breast carcinoma, endometrial carcinoma and photosensitivity). Tumour-like lesions of the liver have also been reported. The presentation of such tumours, their management and pathologic features are reviewed. The biochemical effects of the oral contraceptive on the liver, with particular reference to jaundice, are discussed in detail.
PIP: This paper discusses the hepatic and biochemical effects of OCs (oral contraceptives) based on a review of current literature on the subject. The histological and pathologic features of liver tumors are described, as are the different etiological agents (diethylstilbestrol and androgenic anabolic steroids) and methods used in the management of liver tumors (laparotomy; normal tissue excision; liver scanning and ultrasonography; clinical surveillance; further pregnancies are not recommended). Estrogens and progesterones were found not to be highly cytolitic to liver cells, with estrogen being more cholestatic than progesterone. When given alone, neither is capable of producing high transaminasemia. When progestogens are given simultaneously, the cholestatic effect of estrogens is enhanced. Contraindications to OC use are cholestasis of pregnancy; constitutional hyperbilirubinemia; primary biliary cirrhosis within 6 months after infectious hepatitis and preexisting chronic liver disease. Development of jaundice or an increase in serum glutamic pyruvic transaminase concentration and retention of bromsulfalein are not considered contraindications to OC use. The lowest possible dose of estrogens should be used to achieve contraceptive effect. During the 1st 2 months of OC use, the pill user should have her blood tested for bilirubin weekly. Darkening of urine necessitates further examination. Possibility of liver tumors in pill users should be considered. Any fertile-aged OC user may experience spontaneous rupture of liver with evidence of hemoperitoneum. Benign tumor as a cause of hemoperitoneum should be excised together with the smallest amount of normal liver tissue necessary to achieve hemostasis.