The relationship between liver problems and contraceptive methods

The use of medications is often unavoidable, especially in cases of more serious health problems. When the effects of the medication take hold and the illness subsides, we often forget even the name of the drug. However, behind the functioning of medications, complex biochemical processes are at play, which most people are not aware of. The active ingredient of the medication is not always the molecule found in the tablet or capsule; the actual active substance often arises as a result of the drug’s breakdown. This is particularly true for hormonal contraceptives.

The liver plays a prominent role in the breakdown of medications, as it is here that the chemical transformations occur, during which medications and toxins ingested with food are broken down and eventually excreted from the body in feces. Thus, the liver becomes a kind of chemical kitchen, where enzymes work together to break down various compounds.

Medications, especially those taken orally, first reach the liver, where their breakdown begins immediately. This phenomenon, known as the “first pass mechanism,” results in the fact that the active ingredient content of medications often needs to be increased to ensure that enough active substance remains by the time it reaches the target organ. In the case of hormonal vaginal rings, however, the active substance enters the bloodstream directly, thus bypassing this mechanism, which allows for sufficient effects with a lower hormone content.

The Role of the Liver in Drug Metabolism

The liver is one of the most important organs in the human body, performing numerous vital functions, including the breakdown of medications and toxins. The active ingredients of medications are transformed in the liver by various enzymes, allowing the body to rid itself of them. Enzymes, which are proteins, play a key role in the metabolism of drugs, as they are necessary for the chemical transformation of the compounds to be broken down.

During the breakdown of medications, the liver disassembles the compounds into smaller components, which are then transported to the intestine via bile and ultimately removed from the body through feces. This process helps prevent the accumulation of medications or ingested toxins in the body, which could lead to poisoning. Thus, the liver acts as a filter that protects the body from potentially harmful substances.

Orally administered drugs, such as contraceptives, are absorbed from the intestine and first reach the liver, where their breakdown begins. This process also justifies the need for a higher active ingredient content in certain medications, as a portion of the active ingredient breaks down in the liver before reaching the target organ. In contrast, in the case of hormonal vaginal rings, the active ingredient enters the bloodstream directly, thus bypassing the liver’s breakdown processes, and a lower hormone content is sufficient to achieve the desired effect.

Disorders of Liver Function and Their Consequences

Disorders of liver function can arise from various diseases that affect the efficiency of drug metabolism. The most common causes include inflammation, degenerative diseases, congenital metabolic disorders, and mechanical obstructions such as gallstones. Liver inflammation is often of viral origin, and toxic exposures, particularly to alcohol, can cause irreversible damage to liver cells.

If inflammation becomes chronic or if a degenerative disease such as liver cirrhosis develops, the function of liver cells may decline, ultimately leading to the organ’s failure. Liver cirrhosis is a serious condition that typically leads to death if a liver transplant does not occur. In cases of congenital metabolic disorders, pathological metabolic products may accumulate in the liver, which can also pose problems for drug metabolism.

In cases of gallstones, the flow of bile towards the intestine is obstructed, leading to inflammation and liver damage. Tumors, whether benign or malignant, are also space-occupying processes that can reduce the number of functioning liver cells. Liver diseases often present with jaundice, which is a consequence of the accumulation of metabolic products that the liver should remove.

A decrease or cessation in the breakdown of medications can render normally harmless compounds toxic. This is particularly true for hormonal contraceptives, where the concentration of the active ingredient in the blood may increase, enhancing side effects. In cases of liver disease, the dosage of medications must be reduced; however, this is not possible with contraceptives, making their use contraindicated in such situations.

In the case of hormonal vaginal rings, the lower active ingredient content results in a lesser burden on the liver. In certain milder liver diseases, such as some types of congenital metabolic disorders, they may still be used based on medical advice. However, in more severe liver diseases, it is advisable to choose contraceptive methods that do not require the introduction of chemical substances into the body, such as the use of condoms or intrauterine devices.