Selection of a method of contraception in patients with liver disease can be complicated. Tubal ligation should be considered in the setting of chronic liver disease for those patients who have completed families. Multiple reversible methods of contraception are currently available but may affect hepatic disease. Estrogen-containing contraceptive methods are contraindicated in patients with acute liver disease. Progestin contraceptives appear to be safe and multiple delivery systems are available. With rare exception, barrier methods and the intrauterine device may be offered as alternative methods.
PIP: Women with liver disease require careful contraceptive management. Of particular salience is the impact of sex steroids on liver function. If patients with chronic liver disease have completed their families, tubal ligation should be considered. Estrogen-containing oral contraceptives have been associated with cholestasis and development of hepatic adenoma and are contraindicated in women with acute liver disease. Progestin-containing hormonal methods appear to be safe, however. IUDs or barrier methods such as condoms and diaphragms can be selected, but they have lower efficacy rates.