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We present a case involving a 19-year-old female who exhibited significant conjugated hyperbilirubinemia shortly after the commencement of OC therapy. Comprehensive investigations ruled out alternative causes, and the findings from liver biopsy, in conjunction with the clinical context, indicated an estrogen-induced cholestatic injury, likely revealing an underlying Dubin\u2013Johnson syndrome. This case underscores the critical necessity of acknowledging hepatic adverse effects associated with estrogen as well as the influence of genetic susceptibility in drug-related adverse events.<\/jats:p>","DOI":"10.1177\/23247096261435540","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T10:09:50Z","timestamp":1774346990000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["When Birth Control Turns Biliary: A Rare Case of Profound Hyperbilirubinemia From Oral Contraceptives"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6372-8082","authenticated-orcid":false,"given":"Taiwo","family":"Ajani","sequence":"first","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9538-0416","authenticated-orcid":false,"given":"Aura","family":"Calderon","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2241-3673","authenticated-orcid":false,"given":"Jose","family":"Loayza Pintado","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayiri","family":"Derian","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Matos","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Mogollon","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2884-1755","authenticated-orcid":false,"given":"Andres","family":"Suarez","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2024.101401"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1088"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.761255"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.14309\/crj.0000000000000776"},{"key":"e_1_3_2_6_2","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases. 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