▎ WuXi AppTec content team editor
Many friends guessed the cerebral infarction. But the specific cause of cerebral infarction, everyone has not yet come up with the answer.
What the hell is going on? Let's see the truth.
The last issue of the truth review
In yesterday's mystery case, we mentioned that in addition to the headache after Ms. Ming's drunkenness, she also had illiteracy and could not write her own name in the later stages, indicating that local brain function has been affected - yes, this is the symptom of stroke (cerebral infarction or cerebral hemorrhage).
Image credit: 123RF
After a series of tests, the doctor found that she had bleeding from the top of her left temporal fist and an elevated level of D-dimer in her coagulation function— suggesting not only cerebral hemorrhage, but possibly thrombosis.
At this time, Ms. Ming's consciousness became more and more unclear, her speech was slurred, and she also had a squirting vomit, and then fell into a coma.
Considering that some drugs may cause hypercoagulable blood and induce blood clots, the doctor asked her friend: Has Ms. Ming taken any medicine recently?
As a result, I really got an important clue - Ms. Ming's previous menstrual irregularities, and because she was unmarried and had no fertility plans, she heard that contraceptives can adjust menstruation, so she bought her own medicine to eat, and has eaten for more than half a year.
Based on the previous results and the history of contraceptive use, the doctor immediately arranged for a cerebral magnetic resonance imaging (MRV) examination, and invited multidisciplinary experts to consult, ruled out arteriovenous malformations, and finally diagnosed intracranial venous sinus thrombosis.
Image source: References[3]
After emergency surgery, the blood clots up to a few centimeters long were removed, and the hematoma was finally removed, and Ms. Ming was saved.
Before being discharged from the hospital, the doctor advised: "Oral contraceptives may increase the risk of blood clots, and you should not take them casually, especially if you can no longer take them." If you want to regulate your menstruation, go to the gynecologist first. ”
Popular science time
As we all know, the "birth control pill" is a drug that helps women avoid pregnancy. However, most people do not understand that the way different contraceptives are taken, the effects and adverse reactions vary greatly.
Depending on the duration of action, contraceptives are divided into 3 categories: short-acting contraceptives, long-acting contraceptives and emergency contraceptives.
Among them, long-acting oral contraceptives are compound, only need to be taken once a month, but due to the high estrogen content and the risk of adverse reactions, the current use has been very little.
Emergency contraception is the legendary "regret pill", taken within 72 hours after unprotected sex or contraceptive failure, the main ingredient is a large dose of progesterone, and the adverse reactions will be relatively more.
The type of short-acting oral contraceptives (also called compound oral contraceptives) that Ms. Ming ate in the case is the most commonly used and effective to be taken continuously, which is also the category we mainly talk about today.
It contains low doses of estrogen and progesterone (similar to the natural estrogen-progesterone in women's bodies), has fewer side effects, and is generally taken from the 1-5th day of menstruation, taking 1 tablet per day for 21-28 days.
In addition to contraception, it can also help regulate menstruation and treat diseases caused by endocrine problems such as polycystic ovary syndrome and premature ovarian failure.
But it has also been found that taking short-acting contraceptives may increase the risk of thrombosis. Deep vein thrombosis and pulmonary embolism are common, but there are also rare upper extremity and intra-abdominal thrombosis, intracranial venous sinus thrombosis (as in Ms. Ming's case), and superficial vein thrombophlebitis.
Intracranial vein thrombosis, if not treated in time, may lead to a sustained increase in intracranial pressure, such as the final bilateral optic nerve atrophy, binocular blindness, or hemiplegia aphasia, or even life-threatening.
The mechanism currently thought to be that oral contraceptives have an effect on both procoagulant and anticoagulant processes, leading to an increase in blood viscosity, which triggers thrombosis.
So, is it a question of estrogen or progesterone? What dosages and ingredients are safer? There has been a great deal of research on this.
1. Estrogen
Taking acetylene estradiol as an example, if the content of ethinyl estradiol in oral contraceptives is more than 20 μg, the higher the content, the risk of venous thrombosis will increase by 3 to 6 times.
Wherein, the content of ethinyl estradiol is 50 μg, than
2. Progesterone
Oral contraceptives are divided into four generations according to the age at which progesterone was first produced:
The first generation (60s): mainly norethindrone, which is now rarely used;
Second generation (1970s): mainly levonorgestrel, norethisterone;
Third generation: mainly pregnedienone (80s); desogestrel (90s);
Fourth generation: drospirenone, cyprotergestrel acetate, etc.
Studies have found that third- and fourth-generation progestogen contraceptives may have a higher risk of thrombosis.
For example, many case studies have found that contraceptives containing third-generation progestogens (pregnenosterone or desogestrel) have a 1.5-3-fold increased risk of thrombosis compared with oral contraceptives containing the second-generation progestin (levonorgestrel) and oral contraceptives containing fourth-generation progestins (levonorgestrel) are at a higher risk of thrombosis than oral contraceptives containing second-generation progesterone (levonorgestrel) and have a comparable risk to third-generation progesterone.
Therefore, combined oral contraceptives containing second-generation progestin (levonorgestrel) + 30 μg of estrogen may be the safest and the lowest risk of thrombosis. For women who use oral contraceptives for the first time, it is especially recommended as the first choice.
However, on the whole, the probability of such adverse reactions is still not high, and there will be a few to a dozen cases per 10,000 people every year, and everyone does not have to worry too much.
Image credit: 123RF
The key is to take it under the guidance of a doctor, do not blindly buy it and eat it, but also see if you are a high-risk group.
Studies have found that these populations have a higher risk of thrombosis during oral contraceptives:
Women with congenital or acquired thrombosis tendencies (hypercoagulable blood, associated genetic defects, or thrombophilia), history of thrombosis, or family history;
The risk is higher in the first 6-12 months of the first taking of the drug, especially in women who take the drug for the first time (the risk disappears after 3 months after stopping the drug);
Women over the age of 40 have a higher risk of thrombosis than younger women;
Smoking and drinking (Ms. Ming often gathers for drinks, which may be related);
There are acquired risk factors such as obesity, diabetes, hypertension, hyperlipidemia, polycystic ovary syndrome, and other cardiovascular diseases;
Women with migraines, especially those with aura, are at higher risk.
While women are pregnant and postpartum, the risk of venous thrombosis itself increases (especially in the first week after childbirth), and the World Health Organization recommends:
Breastfeeding women who are breastfeeding for 6 months after childbirth: the use of combined oral contraceptives is not recommended.
Non-breastfed women within 21 days of the puerperal period, with other venous thrombosis factors (e.g., previous history of thrombosis, propensity to thrombosis, prolonged lying stillness, smoking, body mass index >30 kg/m2, transfusion during delivery, postpartum bleeding, post-caesarean section, pre-eclampsia): risk needs to be assessed comprehensively based on the number and severity of risk factors.
For high-risk groups, it is actually more recommended to prefer non-hormonal contraceptive methods (such as the use of condoms, copper-containing intrauterine contraceptives, etc.) or the use of progestin-only contraceptives (progestin-only oral contraceptives, subcutaneous implants, etc.).
Risk factors can be changed, if there is no other choice, you must take oral contraceptives, then you must pay attention to smoking cessation, alcohol cessation, weight loss, healthy diet, more exercise, change bad living habits, and then after the doctor's assessment, follow the doctor's instructions to take the medicine.
During the medication, if there are repeated headaches, fevers, mental abnormalities (such as sluggish eyes, slow response), can not see clearly, literacy or speech disorders, nausea and vomiting, one limb is unconscious (hemiplegia), convulsions and other symptoms, you must be vigilant, be sure to seek medical treatment in time.