Can patients with hypercholesterolemia be given Oral Contraceptive Pills (OCPs)?

From the Guidelines

Women with elevated cholesterol can generally be prescribed oral contraceptive pills (OCPs), but the decision requires careful consideration, as stated in the most recent study 1. The study highlights the importance of individualized decisions when prescribing OCPs, considering the potential risks of hypertension, cardiovascular disease, and venous thromboembolism. For women with mildly to moderately elevated cholesterol, combined hormonal contraceptives containing both estrogen and progestin are usually acceptable, according to the review of current evidence and recommendations 1. However, women with severely elevated cholesterol (particularly LDL cholesterol above 160 mg/dL) or those with multiple cardiovascular risk factors may be better suited for progestin-only contraceptives like the mini-pill, hormonal IUDs, or implants, as suggested by the study on oral contraceptive pills and hypertension 1. Some key points to consider when prescribing OCPs to women with elevated cholesterol include:

• Estrogen-containing OCPs can potentially increase triglycerides and LDL cholesterol while raising HDL (good) cholesterol, as noted in the study on the management of arterial hypertension 1.
• Regular monitoring of lipid levels is recommended after starting OCPs, typically at 3 months and then annually.
• Women with elevated cholesterol should also adopt lifestyle modifications including a heart-healthy diet, regular exercise, weight management, and smoking cessation. The decision to prescribe OCPs should balance contraceptive needs against cardiovascular risk, with progestin-only methods generally being safer for women with significant hyperlipidemia or additional cardiovascular risk factors, as supported by the most recent study 1.

From the FDA Drug Label

Women who are being treated for hyperlipidemias should be followed closely if they elect to use oral contraceptives Some progestogens may elevate LDL levels and may render the control of hyperlipidemias more difficult. The risk of myocardial infarction for current oral contraceptive users has been estimated to be two to six (4 to 10). The risk is very low in women under the age of 30 Oral contraceptives may compound the effects of well-known risk factors, such as hypertension, diabetes, hyperlipidemias, age and obesity

Elevated Cholesterol and OCP Use:

• Women with elevated cholesterol should be cautious when using oral contraceptives (OCPs) as some progestogens may elevate LDL levels and make it more difficult to control hyperlipidemias.
• The risk of myocardial infarction is increased in women with underlying risk factors such as hypercholesterolemia.
• It is recommended that women with hyperlipidemias be followed closely if they elect to use OCPs 2.
• OCPs should be used with caution in women with cardiovascular disease risk factors, including hypercholesterolemia 2.

From the Research

Elevated Cholesterol and Oral Contraceptives

• There is limited direct evidence on the use of oral contraceptives (OCs) in individuals with elevated cholesterol levels.
• A study from 1980 3 compared the metabolic effects of four oral contraceptive formulations and a contraceptive vaginal ring, finding that the groups receiving the compounds with 30 or 35 micrograms of estrogen had a slight decrease in cholesterol levels.
• However, this study did not specifically focus on individuals with elevated cholesterol levels, and the results may not be generalizable to this population.
• Other studies have investigated the effects of lifestyle changes, such as physical activity 4 and dietary modifications 5, on cholesterol levels and cardiovascular risk, but these studies did not address the use of OCs in individuals with elevated cholesterol.

Cardiovascular Risk and Oral Contraceptives

• A study from 2018 6 found that oral hormonal therapy with ethinylestradiol-levonorgestrel improved insulin resistance, obesity, and glycogen synthase kinase-3 in estrogen-deficient rats, but this study did not directly address the use of OCs in individuals with elevated cholesterol levels.
• Another study from 2020 7 discussed the treatment of hypercholesterolemia and cardiovascular disease, but did not mention the use of OCs in individuals with elevated cholesterol levels.

Conclusion is not allowed, the response will continue with more information

• It is essential to consult with a healthcare provider to determine the best course of treatment for individuals with elevated cholesterol levels who are considering using oral contraceptives.
• The healthcare provider can assess the individual's overall health and medical history to determine the potential risks and benefits of using OCs.
• Additionally, the healthcare provider can discuss alternative forms of birth control and provide guidance on lifestyle changes that can help manage cholesterol levels and reduce cardiovascular risk 4, 5.