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Question answered:12/03/08
According to the Faculty of Sexual and Reproductive Healthcare:
"Benign intracranial hypertension is an uncommon condition, which presents most often in women of reproductive age. The incidence in women 15 –44 years is 3.5 per 100, 000. The pathophysiology is unknown but it has been associated with: a number of drugs including hormones such as estrogen; various illnesses such as disseminated lupus erythematosus, sarcoidosis; infectious diseases including acquired immune deficiency syndrome (AIDS); chronic renal failure; and obesity. Importantly it has also been associated with underlying coagulation disorders such as antiphospholipid syndrome and antithrombin III deficiency. It can present with symptoms associated with the rise in intracranial pressure: headache, visual disturbances, vomiting, confusion, and sensory-motor disturbances. It is therefore important to distinguish it from migraine with focal symptoms or intracranial lesions.
Since estrogen and not progestogens have been implicated in the aetiology of the disorder and are associated with an increase thrombotic risk it is likely they should be given a WHO 4 category (do not use). Therefore it should be noted that the use of combined oral contraception is a WHO category 4.
Although there have been reports to the WHO Collaborating Centre for International Drug Monitoring of BIH in women using progestogen-only contraception (specifically the levonorgestrel subdermal implant) no strong causal relationship has been identified. There is no evidence available on the effects of progestogen-only contraception and the symptoms or clinical course of BIH.
As BIH appears to be estrogen induced rather than progestogen induced progestogen-only methods are a suitable option for this patient."
Source: http://www.fsrh.org/admin/uploads/no.2245.pdf
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