Some Effects of Contraceptive Steroids on Hepatic Function in Normal Women and in Patients with Acquired and Inheritable Defects in Hepatic Excretory Function

Abstract

Although the development of oral contraceptive pills represents a major advance in population control, the use of these agents has introduced several problems relating to jaundice. Table 1 classifies three types of hepatic effects of oral contraceptive steroids. Decreased hepatic excretion of sulfobromophthalein (BSP), regularly seen in women taking oral contraceptives, is not associated with hyperbilirubinemia, and mimics that seen in the last trimester of pregnancy (1) or following administration of estrogens (2) or C-17 alkylated anabolic steroids (3). Jaundice occurring during administration of oral contraceptives may be classified on the basis of whether or not the patient was previously anicteric. The disorders listed in Group 2 are characterized by bile secretory failure manifested by accumulation in serum of conjugated bilirubin, bile salts and cholesterol, increased serum alkaline phosphatase and 5’-nucleotidase activities, and a relatively characteristic lesion of bile canaliculi and lysosomes which is best seen by enzyme histochemical and electron microscopic examinations (4). Occasionally, patients receiving oral contraceptives manifest non-dosage related bile secretory failure and are presumed to be sensitive to the drug although the mechanism is unknown (5). Other patients develop bile secretory failure in association with pregnancy (6) or without obvious precipitating cause (7) and manifest recrudescence of the syndrome following administration of oral contraceptive drugs.