STEROID CONTRACEPTION

A   44-year-old woman,  gravida 4   para    4,  presents    with    questions   about   oral

steroid contraception.  She uses    a   diaphragm   but is  worried about

contraceptive   failure.    She also    expresses   concern that    her menses  have

become  slightly    heavier and more    painful.    She does    not smoke   and has no

other   medical problems.

Steroid contraception inhibits the midcycle luteinizing hormone (LH) surge, thus
preventing ovulation; alters cervical mucus making it thick and viscid, thus
retarding sperm penetration; and alters endometrium, thus inhibiting blastocyst
implantation.

Table II-9-1. Mechanism of  Action  of  Steroid Contraception

Pituitary Decreased LH  surge

Ovary Decreased ovulation

Endometrium Atrophy

Cervix Hostile  mucus

Estrogen-mediated metabolic effects include fluid retention from decreased
sodium excretion, accelerated development of cholelithiasis, increase in hepatic
protein production (e.g., coagulation factors, carrier proteins, angiotensinogen),
healthy lipid profile changes (increased HDL, decreased LDL), and increased
venous and arterial thrombosis.