The effect of oral contraceptives on the liver

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Abstract
Impairment of hepatic function probably is produced frequently by antifertility agents, but in healthy women it is clinically insignificant and transient. Since the effect may be dose related, oral contraceptives should be used in the lowest doses that are effective. Cholestatic jaundice, sometimes in association with high serum transaminase values, develops rarely and is so short-lived as to render these preparations safe for world-wide use. The use of oral contraceptives is contraindicated in women with recurrent cholestasis of pregnancy, constitutional hyperbilirubinemia, and primary biliary cirrhosis. Only a minimal amount of medical and laboratory monitoring is required in patients using oral contraceptives. With respect to hepatic function, the decision to withdraw the medication should be based on the appearance of bile in the urine or the development of jaundice. During the first two months of therapy, at least a weekly check of the urine for bilirubin should be made. Afterwards it may be sufficient simply to caution the patient to return for examination if darkening of the urine or jaundice is noted.