Women
who have never had symptoms but come from
a family with one of the acute porphyrias
should be tested to see whether they are
affected. If they are, they should follow
the advice given above. This is particularly
important for those in their teens and
early twenties, the age group in which
attacks often start. The risk of provoking
an acute attack may be highest for women
with acute intermittent porphyria, high
urinary porphobilinogen (PBG) levels,
or both of these together. If, after receiving
full information about acute porphyria
and discussion of the likely consequences
with their doctor, they do decide to start
on the contraceptive pill, they should
have a urine test for PBG. If the level
is high, the decision to go ahead with
the pill should be reconsidered. Any woman
in this group who starts on the pill should
have her urine tested for PBG at regular
intervals for several months. If PBG levels
increase progressively, the pill should
be stopped. She should also report immediately
to her doctor if abdominal pain or any
other potential indicator of acute porphyria
develops. |