Journal
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY
Volume 320, Issue 1, Pages H77-H89Publisher
AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajpheart.00614.2020
Keywords
endothelial function; macrovascular; microvascular; oral contraceptive pills; smooth muscle function
Funding
- Natural Sciences and Engineering Research Council
- Natural Science and Engineering Research Council Canadian Graduate Scholarship
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Hormonal contraceptives have been found to impact vascular function and structure, with differences in endothelial function in different types of contraceptives. However, they do not seem to affect smooth muscle function, arterial stiffness, or vascular structure. Phasic differences exist in the effects of hormonal contraceptives based on progestin type, ethinyl estradiol-to-progestin ratio, and route of administration.
Hormonal contraceptives are one of the most widely used prescriptions for premenopausal women worldwide. Although the risk of venous and arterial cardiovascular events (e.g., deep vein thrombosis, arterial clotting) with hormonal contraceptives, specifically oral contraceptive pills, has been established, the literature on early risk indicators, such as peripheral vascular structure and function has yet to be consolidated. The purpose of this review is to summarize literature examining the impact of different hormonal contraceptives on vascular function and structure, including consideration of phasic differences within a contraceptive cycle, and to propose future directions for research. It is evident that hormonal contraceptive use appears to impact both macrovascular and microvascular endothelial function, with phasic differences in some contraceptive types dependent on progestin type, the ratio of ethinyl estradiol-to-progestin, and route of administration. However, hormonal contraceptives do not appear to impact smooth muscle function in the macrovasculature or microvasculature, arterial stiffness, or vascular structure. Underlying mechanisms for observed impacts and areas of future research are discussed. This review provides timely consolidation of research examining hormonal contraceptives and peripheral vascular function and structure and provides guidance on considerations for hormonal contraceptive use in study design.
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