Oral contraceptive pill consumption in Hajj and Ramadan as a significant risk of thrombosis in the Islamic countries- A narrative review

During the Ramadan fasting and Haj, the Muslim women prefer to use a short course of OCP as a pilgrim or to be able to fast. Many of them discontinue the pills immediately after the ceremony. Few works of literature have focused on this important topic all over the world.Methods: We have reviewed the Web of Science, Google Scholar, Scopus and PubMed up to December 2018 to find the best results. we performed our search using the keywords: Ramadan, Hajj, Mecca, oral contraceptive pills(OCP), venous thrombosis, vertebral vein thrombosis, mesenteric thrombosis and combination of them.33 studies had the criteria for the final assessment. Almost all of the studies are from the Islamic countries, especially from Iran.Results: Ramadan and Hajj are the two main religious ceremonies in the Islamic countries such as Iran in which OCPs are dramatically overused. It could lead to a catastrophic cerebral vein, mesenteric vein or even other rare venous thromboses. Female involvement is six times more than the males; most of them are young healthy women that could easily be debilitated and work loss. Hence, it leads to a heavy burden on the society and health care system.Conclusion: Fasting is shown as an independent risk factor of Cerebral venous and Dural sinus thrombosis, but hypercoagulability state and OCPs are considered as potential triggers. Genetic basis could be another novel factor in the population. It is strongly recommended to aware the health care providers about the importance of the entity and its subsequent complications.

Keywords:

Oral Contraceptive pill , Hajj , Ramadan , venous thrombosis