Long-term use of birth control pills has been linked to an increased risk of glaucoma. Do you consider glaucoma risk before prescribing hormonal contraception?
Last fall, researchers presented evidence of a significant link between prolonged use of birth control pills (BCPs) and the development of glaucoma later in life. This research involved more than 3,000 women older than 40 who took birth control for at least 3 consecutive years who were given eye exams. These examinations revealed that women who took birth control for 3-plus consecutive years, compared with women who did not take birth control, were twice as likely to have glaucoma.
Prior to the release of this research, which is considered preliminary, there was a conclusion that low estrogen levels were linked to the development of this eye condition. Women who do not take hormonal birth control experience regular fluctuations in estrogen that is thought to make glaucoma less likely to develop.
Optometrists' Clinic Inc. explains glaucoma as a condition resulting from damage to the eye because of elevated intraocular pressure. It is caused by increased fluid production coupled with decreased drainage that causes injury to retinal fibers and the optic nerve. Undiagnosed glaucoma can quickly lead to blindness if this increased pressure is not relieved.
A family history of glaucoma; African American, Hispanic, or Asian ethnicity; a history of corticosteroid use; hypertension; retinopathy; older age at menarche; and a previous eye injury are all risk factors for glaucoma. In general, glaucoma is more likely to occur in persons older than 40 years.
Before women with these and other risk factors for glaucoma are prescribed oral contraceptives, they should be made aware of a possible link between oral contraceptives and glaucoma so that they can make an informed decidion about which birth control method they prefer. More importantly, however, women who have a history of extended use of birth control (3-plus years), particularly those with any of the previously mentioned risk factors, should be encouraged to have regular eye exams (every 2 years).
Although there is no concrete link between BCPs and glaucoma, it’s worth considering that the increased incidence of glaucoma among women with long-term BCP use may be more than just a coincidence. Current evidence may not yet support this connection, and a gynecologist may not think to discuss this with his or her patients, but patients deserve to know the pros and cons of the contraception they are considering, even if the cons occur later in life. Luckily, there are contraceptive options that don’t involve altering hormone levels.
Considering these findings, have your conversations with patients about BCPs changed to include discussions about glaucoma risk?