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

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

Methods: 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 use of HC or after discontinuation of HC. We assessed 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 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 safe use of contraception.