Birth Control Pills & Elevated Liver Enzymes

Many women choose oral contraception because it effectively prevents unplanned conceptions and otherwise fits well with their lives. Some women do experience side effects, including elevated liver enzymes. If you take oral contraceptives or are considering them, you may want to learn more about their effects on the liver. Ask your doctor any questions you may have.

Functions of the Liver

The liver is unique among bodily organs because it can regenerate itself. It can lose as much as 75 percent of its cells before it fails. This ability to sustain and recover from damage is fortunate. Among its over 500 known essential-to-life functions, the liver filters the body's blood supply in order to clear and metabolize many different compounds it perceives as poisonous, including medications.

Drug Metabolism and Interactions

The liver metabolizes most drugs, including oral contraceptives. Thus it can be vulnerable to various kinds of DILIs, or drug-induced liver injuries. The liver is also the site of many drug interactions. One drug may speed up or slow down the rate at which the liver metabolizes another drug, intensifying or hindering its clinical effects. Many drug interactions with oral contraceptives can be explained by metabolic events within the liver. Drug interactions may worsen if DILI is present.

Elevated Liver Enzymes

Liver function is often assessed through blood tests of certain enzymes from the liver. Some of these test results, especially for alkaline phosphatase, or ALP, and total bilirubin, may be higher than normal in some oral contraceptive users. Elevated liver enzymes may result from liver inflammation or damage. Above-normal ALP and total bilirubin may indicate a type of DILI called “cholestatic hepatotoxicity.” This may involve jaundice, a yellowing of the skin and eyes, and sometimes additional and more serious liver problems. If you are on the pill and have elevated liver enzymes, ask your doctor what these test results mean in your case; whether you need further tests and treatments; and whether you should switch birth control methods.

Contraindications

“Family Planning: A Global Handbook for Providers” recommends against combined or estrogen-progesterone oral contraceptives or COCs and progestin-only pills or POPs on several liver-related grounds. Women with liver disorders like tumors, cirrhosis, hepatitis and jaundice, generally should not use COCs or POPs. Because of liver-based drug interactions, this manual also recommends that women on certain antiseizure medications, the anti-tuberculosis drug rifampicin and the anti-HIV drug ritonavir not take COCs or POPs.

Alternatives in Family Planning

If your elevated liver enzymes, other medical conditions, or other medications conflict with COCs, POPs, or other hormonal contraceptives, you still have many family planning alternatives. Ask your doctor about precisely how and when you can switch to nonhormonal IUDs, condoms, a diaphragm, fertility awareness, vasectomy or tubal ligation. Exercise extra caution when and if you begin another family planning method or methods, as women are especially vulnerable to unplanned pregnancies during discontinuation of oral contraceptives.