Long term effects of oral hormonal contraceptives on the urinary tract

ABSTRACT

One Hundred healthy women in the childbearing period and a similar number of pill users for more than three years were investigated. Significant bacteriuria was demonstrated in 36% of pill users compared with 16% in healthy controls. Dilatation of the lower ureter was encountered in 24% of pill users and in 8% of controls. Grade I vesicoureteric reflux was demonstrated in 15 women on oral hormonal contraceptives compared with 4% in controls. Hypotonicity of the urinary tract musculature, as well as other factors, are believed to be responsible for these changes. Periodic urologic investigations are suggested for these who use pills for prolonged time. Structural changes demonstrated in the urinary tract during normal pregnancy have been attributed at least in part to the presence of placental steroid hormones [Youssef, 1956 Fainstat, 1963]. The effects of oral hormonal contraceptives on the upper urinary tract had been studied with contradictory results. Marshall et al., [1966] observed dilatation of the ureters and renal pelvis in women using oral hormonal con-pills were discontinued. However felding [1966] who followed a small group of women taking Anovlar I for 3-9 months, found no radiologic evidence of ureteral dilatation. Descending urograms were normal in 10 patients on oestrogen-progestagen combination studied by Marchant [1972]. Couriere et al., [1970] observed no urologic changes in women after year of pill use. Recently, Youssef et al., [1975] demonstrated bladder hypotonia and increased capacity durign the use of oral hormonal contraceptive which was more manifest during the second year. Aaso, Zahran et al., [1976] observed bladder trabeculations in pill users. However, the susceptibility of the urinary system to infection after servical years of pill use is not clear. In most of the reports, the duration of pill use was in the range of 1-3 years [Courriere et al., 1970 and Zahran et al., 1976]. This stimulated us to study women on oral hormonal contraceptives for more than three years