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Review
. 2025 Jul 7:111012.
doi: 10.1016/j.contraception.2025.111012. Online ahead of print.

Safety of hormonal contraception among women with liver disease: an updated systematic review

Nathalie Kapp  1 , Naomi K Tepper  2 , Antoinette T Nguyen  2 , Sophia Garbarino  2 , Katherine Kortsmit  2 , Kathryn M Curtis  2 , Maura K Whiteman  2
Affiliations
Review

Safety of hormonal contraception among women with liver disease: an updated systematic review

Nathalie Kapp et al. Contraception. .

Abstract

Objectives: We sought to assess whether, among women with liver disease, there is an increased risk of adverse health effects with the use of hormonal contraception (HC).

Study design: We conducted a systematic review of six databases from database inception through December 13, 2022. We searched for articles that examined changes in liver lesions and acute and chronic liver disease with the use of HC or after discontinuation of HC. We assessed the risk of bias for each study and certainty of evidence for all outcomes.

Results: Thirteen articles met inclusion criteria, one with low risk of bias and the others with high risk of bias: three studies (four articles) were of women with focal nodular hyperplasia (FNH), five studies were of hepatocellular adenoma (HCA), and four studies were of acute or chronic hepatitis. The size and/or number of FNH lesions were generally not influenced by HC use. HCA progression was generally higher among current combined oral contraception (COC) users than those who discontinued, and lesions were stable or regressed in most women who discontinued COC or used progestin-only contraception. Studies found that viral hepatitis generally did not progress or increase in severity with the use of COC.

Conclusion: Overall, a limited body of evidence suggested changes in FNH lesions were independent of hormonal contraceptive use. Estrogen-containing contraceptive method use was associated with HCA lesion progression; lesions generally remained stable with progestin-only contraceptive use. COC use did not increase progression or severity of disease among those with viral hepatitis. The certainty of evidence for all outcomes was very low.

Implications: Liver conditions such as liver lesions, viral hepatitis, and cirrhosis are increasingly common in women of reproductive age. Information in this review can be used by health care providers when counseling women with liver disease about the safe use of contraception.

Keywords: Combined oral contraception; Focal nodular hyperplasia; Hepatitis; Hepatocellular adenoma; Hormonal contraception; Liver disease; Systematic review.

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Conflict of interest statement

Conflicts of interest: The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart for the search process for evidence on the safety of hormonal contraception among women with liver disease. PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.
Fig. 2.
Fig. 2.
Risk of bias for studies on liver lesions.
Fig. 3.
Fig. 3.
Risk of bias for studies on hepatitis.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Chronic liver disease and cirrhosis. 〈https://www.cdc.gov/nchs/fastats/liver-disease.htm〉 (accessed December 23, 2024).
    1. Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, et al. Reproductive health and liver disease: practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021;73:318–65. 10.1002/hep.31559 - DOI - PubMed
    1. Winkler UH. Effects of androgens on haemostasis. Maturitas 1996;24:147–55. 10.1016/s0378-5122(96)82004-4 - DOI - PubMed
    1. Sitruk-Ware R Pharmacological profile of progestins. Maturitas 2004;47:277–83. 10.1016/j.maturitas.2008.11.011 - DOI - PubMed
    1. Kuhl H Effects of progestogens on haemostasis. Maturitas 1996;24:1–19. 10.1016/0378-5122(96)00994-2 - DOI - PubMed

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