Microvascular endothelial function following cessation of long‐term oral contraceptive pill use: A case report

• Published in: Experimental physiology Vol. 108; no. 1; pp. 5 - 11
• Main Authors: Turner, Casey G., Stanhewicz, Anna E., Nielsen, Karen E., Wong, Brett J.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-01-2023; Wiley
• Subjects: Bioavailability; Blood flow; case report; Case reports; Contraceptives, Oral - pharmacology; Doppler effect; Endothelium; Female; Humans; Microdialysis; Microvasculature; Nitric Oxide; Oral contraceptives; Regional Blood Flow - physiology; Retrospective Studies; Skin - blood supply; Vasodilation; Vasodilation - physiology; women; endothelium; oral contraceptives; case report; nitric oxide; women
• ISSN: 0958-0670; 1469-445X
• DOI: 10.1113/EP090861

New Findings
What is the main observation in this case?
The main observation of this case report is substantial improvement in cutaneous microvascular endothelial function after cessation of long‐term use of a fourth‐generation oral contraceptive pill. This improvement appears independent of relative changes in the contribution of nitric oxide.
What insights does it reveal?
Our findings suggest that cessation of long‐term, fourth‐generation oral contraceptive pill use improves endothelial function within 20 months of cessation.
The purpose of this case report was to evaluate in vivo endothelial function and nitric oxide (NO)‐dependent vasodilatation before and after the cessation of long‐term (11–12 years) fourth‐generation oral contraceptive pill (OCP) use in one young, healthy and premenopausal woman. This retrospective analysis includes data from six experimental visits: three visits during months 133–144 of fourth‐generation OCP use and three visits 19–22 months after OCP cessation. Endothelium‐dependent and NO‐dependent vasodilatation were assessed in the cutaneous microvasculature using laser‐Doppler flowmetry, a rapid local heating protocol (39°C, 0.1°C/s) and pharmacological perfusion through intradermal microdialysis fibres. The participant had consistent medical history and lifestyle behaviours throughout both hormonal exposures. Data are presented as the mean (SD). Endothelium‐dependent vasodilatation was 42 (10)% of site‐specific maximal cutaneous vascular conductance (CVCmax) during OCP use and 63 (10)%CVCmax after OCP cessation (49% increase). Nitric oxide‐dependent vasodilatation was 70 (5)% contribution of NO during OCP use and 60 (15)%NO after OCP cessation (15% reduction). Baseline blood flow was greater after OCP cessation, but maximal blood flow was reduced. Data from this case report support a substantial increase in cutaneous microvascular endothelial function assessed via local heating after cessation of long‐term use of a fourth‐generation OCP, which does not appear to be attributable to increased NO bioavailability. Overall, these data suggest an improvement in endothelial and microvascular function after the cessation of long‐term use of a fourth‐generation OCP.