However, with the exception of women 35 years and older who smoke and nonsmokers 40 and older, the risk of mortality associated with all methods of birth control is less than that associated with childbirth. Since cigarette smoking increases the risk of serious side-effects, women who use oral contraceptives should be strongly advised not to smoke. Hypertension may occur in association with the use of oral contraceptives. Regular blood pressure checks, including a pretreatment level, are advisable. Prolonged amenorrhoea following the use of oral contraceptives may occur.
Caution is advised where oligomenorrhoea or amenorrhoea have occurred in the past.
Mood changes, mass gain, skin pigmentation, ocular lesions, vaginal candidiasis, gall bladder disease, jaundice, gastrointestinal irritation and fluid retention may occur. Case reports have been published of benign hepatic tumours in women on oral contraceptives for a prolonged time, but a causal relationship has not been established. The preparation should be discontinued if persistent upper abdominal pain develops. For maximal protection, additional non-hormonal contraception should be recommended for the duration of antibiotic therapy and for seven days afterwards. Those on longterm antibiotic therapy need only take extra precautions for the first two weeks of antibiotic therapy.