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Gynecology Malpractice in Prescribing Oral Contraceptives

Oral contraceptives, or birth control pills, operate by altering the hormonal structure of the body. For this reason, they have more side effects than other forms of contraception. Therefore, the decision to use birth control pills should only be made after the physician takes a careful history, does a thorough examination, and discusses all possible risks with the patient. Due to the nature of oral contraceptives and the possibly of adverse effects, informed consent is crucial.

One of the most serious complications that may occur from the use of birth control pills arises from changes in the cardiovascular system. The synthetic estrogen in the pills increases the clotting factors, but the risk of thromboembolic disease has decreased as the result of lower estrogen formula pills. The use of oral contraceptives has been shown to increase the occurrence of migraine headaches and to possibly increase blood pressure.

Changes in a woman's reproductive tract may result from the use of birth control pills, but the connection between the use of oral contraceptives and cervical cancer is not clear. However, until more studies are completed, physicians should recommend regular cervical cancer screening for women on birth control pills.

Oral contraceptives can produce several skin disorders such as those naturally occurring during pregnancy. These problems are exacerbated by exposure to the sun and take a long time to disappear after discontinuing the use of birth control pills.

Generally, a physician should not prescribe oral contraceptives for any woman who has high risk factors for vascular disease. These factors include a history of deep-vein thrombosis, pulmonary embolus, sickle cell disease, stroke, lupus erythematosus with clinical vascular association, atherosclerosis, diabetes with vascular complications, uncontrolled high blood pressure, cigarette smoking (if the woman is over age 35), congestive heart failure, and organic heart disease.

Women who are pregnant should not use oral contraceptives, nor should women with undiagnosed abnormal uterine bleeding, active liver disease, intestinal malabsorption, or the use of certain drugs. In addition, an increased incidence of migraine headaches, fainting, loss of vision or speech, or paresthesia can be indications that a woman is going to have a stroke, and the use of oral contraceptives should be stopped immediately.

If there are no contraindications to prescribing birth control pills, a physician is using reasonable care if, after an examination and a history, he or she performs a complete blood count, a urinalysis, and a Pap test. Normally, the patient should be seen again in three months and then annually for a full examination.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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