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The pill & increased liver values

Dear expert team,

I would like to know if there is any experience concerning the contraceptive pill and increased liver values in women with CF. Since the pill is supposed to slightly increase the liver values even in healthy people, I would like to know what to keep in mind when taking the pill as a CF patient. Would you generally recommend taking ursodeoxychloic acid together with the pill, if it has not been taken so far?

Apparently medical opinions differ here – is ursodeoxycholic acid generally considered a standard therapy in CF, or does one only start taking it when alterations in the liver become evident?

Many thanks and kind regards,
Mother of 16-year-old CF daughter
Dear questioner,

You would like to know what to keep in mind concerning the liver function as a CF patient who would like to take oral contraceptives (pill). You are also asking whether ursodeoxycholic acid should generally be added to therapy prophylactically during oral contraception, and also by default to basic CF therapy.

It is true that oral contraceptives can have hepatic (i.e., liver-related) side effects. Therefore, both a gynaecologist and a CF doctor should always be consulted before beginning to take the pill. Here you can decide whether oral contraception is suitable for the individual patient or whether she should choose a different contraceptive method. Usually, women with CF who would like to take precautions can definitely take oral contraceptives. It is important to have liver checks (blood test, ultrasound). This is guaranteed if the patient regularly presents to her gynaecologist (every 6 months) and her CF clinic (every 3 months).

Prophylactic administration of ursodeoxycholic acid with oral contraception has not been proven by clinical studies. For patients with slightly increased liver values, using oral contraception (under medical supervision) is not precluded. Since ursodeoxycholic acid improves bile drainage by liquefying the bile, it is mainly used in patients with bile drainage deficiency and a resulting development of gallstones. Due to an increased viscosity of bodily fluids in CF, bile drainage can be insufficient here as well; therefore ursodeoxycholic acid is also used in CF.

Individual clinical studies in the past dealt with the prophylactic use of ursodeoxycholic acid in CF, with the hypothesis that it would be gentle on the liver due to liquefying the bile. This hypothesis continues to make sense, but there has been no proof of an explicitly prophylactic effect of ursodeoxycholic acid in CF so far. Therefore, it is up to the doctor to decide together with the patient, since this question has not yet been clarified by guidelines.

Kind regards,
Dr. Christina Smaczny
Even the "standard" use of ursodeoxycholic acid in the context of CF assoicated liver disease is under debate.
Please find more under the following Q/A:

D. d'Alquen