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Oral contraception: risks and benefits

Summary

Data on the risks and benefits of using the oral contraceptive continue to accumulate. Because of continuing changes in the formulation and dosage of both the estrogens and progestins, the medical community must constantly re-evaluate all older data when considering current risk/benefit ratios. The changes in pill formulation have led to increased acceptability with a reduction of both nuisance and serious long-term side effects. The risks must be balanced against the major contraceptive and non-contraceptive benefits that are provided by the pill. Although both the benefits and risks have been documented in the literature, both the physician and the patient are being overwhelmed by press reports stressing mainly the negative aspects of the pill.

It is incumbent on all physicians to periodically review the sources and validity of all medical reports on the pill. While the benefits of the pill outweigh the risks, the physician must be constantly aware of the changing world literature in order to optimize his/her prescribing patterns.

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References

  1. 1.

    KhooskJ. (1986). Cancer risks and the contraceptive pill: what is the evidence after nearly 25 years of use?Med. J. Aust.,144, 185

  2. 2.

    SartwellP.E. and StolleyP.D. (1982). Oral contraceptives and vascular disease.Epidemiol. Rev.,4, 95

  3. 3.

    Ory, H., Forrest, J.D. and Lincoln, R. (1983). Making choices. Evaluating the health risks and benefits of birth control methods.Alan Guttmacher Institute, 3–5

  4. 4.

    HeintzA.P., HackerN.F. and LagasseL.D. (1985). Epidemiology and etiology of ovarian cancer: A review.Obstet. Gynecol.,66, 127

  5. 5.

    Centers for Disease Control Cancer and Steroid Hormone Study (1983). Oral contraceptive use and the risk of ovarian cancer.J. Am. Med. Assoc.,249, 1596

  6. 6.

    RosenbergL., ShapiroS., SloneD. et al. (1982). Epithelial ovarian cancer and combination oral contraceptives.J. Am. Med. Assoc.,247, 3210

  7. 7.

    DermanR. (1986). Oral contraceptives: assessment of benefits.J. Reprod. Med.,31 (suppl. 9), 879

  8. 8.

    WeissN.S. and SayvetzT.A. (1980). Incidence of endometrial cancer in relation to the use of oral contraceptives.N. Engl. J. Med.,302, 551

  9. 9.

    KaufmanD.W., ShapiroS. and SloneD. (1980). Decreased risk of endometrial cancer among oral contraceptive users.N. Engl. J. Med.,302, 551

  10. 10.

    HulkaB.S., ChamblessL.E. and KaufmanD.G. (1982). Protection against endometrial carcinoma by combination-product oral contraceptives.J. Am. Med. Assoc.,247, 475

  11. 11.

    Centers for Disease Control Cancer and Steroid Hormone Study (1983). Oral contraceptives use and the risk of endometrial cancer.J. Am. Med. Assoc.,249, 1600

  12. 12.

    OryH.W. and the Boston Collaborative Drug Surveillance Program (1974). Functional ovarian cysts and oral contraceptives: negative association confirmed surgically.J. Am. Med. Assoc.,228, 68

  13. 13.

    SenanayakeP. and KramerD.G. (1980). Contraception and the etiology of PID; new perspectives.Am. J. Obstet. Gynecol.,138, 852

  14. 14.

    Royal College of General Practitioners' Oral Contraception Study (1974).Oral Contraceptives and Health, Pitman, New York

  15. 15.

    PorterJ.B., HunterJ.R. and StergachiA. (1985). Oral contraceptives and nonfatal vascular disease.Obstet. Gynecol.,66, 1

  16. 16.

    ConnellE.B. (1984). Oral contraceptives: the current risk benefit ratio.J. Reprod. Med.,29 (suppl. 7), 513

  17. 17.

    Royal College of General Practitioners' Oral Contraception Study (1977). Effect on hypertension and benign breast disease of progestogen compounds in combined oral contraceptives.Lancet,1, 624

  18. 18.

    Collaborative Group for the Study of Stroke in Young Women (1975). Oral contraceptives and stroke in young women: Associated risk factors.J. Am. Med. Assoc.,231, 718

  19. 19.

    VesseyM.P., LawlessM. and YeatesD. (1984). Oral contraceptives and stroke: findings in a large prospective study.Br. Med. J.,289, 530

  20. 20.

    Royal College of General Practitioners' Oral Contraception Study (1987). Further analyses of mortality in oral contraceptive users.Lancet,1, 541

  21. 21.

    KayC.R. (1982). Progestogens and arterial disease: Evidence from the Royal College of General Practitioners' Study.Am. J. Obstet. Gynecol.,142, 762

  22. 22.

    RealiniJ.P. and GoldzieherJ.W. (1985). Oral contraceptives and cardiovascular disease: A critique of the epidemiologic studies.Am. J. Obstet. Gynecol.,152, 729

  23. 23.

    ShapiroS., SloneD., RosenbergL. et al. (1979). Oral contraceptive use in relation to myocardial infarction.Lancet,1, 743

  24. 24.

    JickH., DinanB. and RothmanK.J. (1978). Oral contraceptives and nonfatal myocardial infarction.J. Am. Med. Assoc.,239, 1403

  25. 25.

    WynnV., DoarJ.W.H. and MillsG.L. (1966). Some effects of oral contraceptives on serum lipid and lipoprotein levels.Lancet,2, 720

  26. 26.

    ShawR.W. (1987). Adverse long-term effects of oral contraceptives: A review.Br. J. Obstet. Gynaecol.,94, 724

  27. 27.

    Clarke, E.A., Hatcher, J., Eyssen, G.E. and Lickrish, G.M. (1985). Cervical dysplasia: association with sexual behavior, smoking and oral contraceptive use?Am. J. Obstet. Gynecol., 612

  28. 28.

    OryH.W., CongerS.B., NaibZ. et al. (1977). Preliminary analysis of oral contraceptive use and risk of developing premalignant lesions of the uterine cervix. InPharmacology of Steroid Drugs, S.Garrantini and H.W.Berendes, eds., Raven Press, New York, p. 221

  29. 29.

    VesseyM.P., LawlessM., McPhersonK. et al. (1983). Neoplasia of the cervix uteri and contraception: A possible adverse effect of the pill.Lancet,2, 930

  30. 30.

    World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives (1985). Invasive cervical cancer and combined oral contraceptives.Br. Med. J.,290, 961

  31. 31.

    Zur HausenH. (1982). Human genital cancer: synergism between two virus infections or synergism between a virus infection and initiating events?Lancet,2, 1370

  32. 32.

    SternE., ForsytheA.S., YoukelesL. et al. (1977). Steroid contraceptive use and cervical dysplasia: Increased risk of progression.Science,196, 1460

  33. 33.

    Armed Forces Institute of Pathology. Hepatic Branch, and Centers for Disease Control, Bureau of Epidemiology, Family Planning Evaluating Division (1977). Increased risk of hepatocellular adenoma in women with long-term use of oral contraceptives.M.M.W.R.,26, 293

  34. 34.

    KeiferW.S. and ScottJ.C. (1977). Liver neoplasms and the oral contraceptives.Am. J. Obstet. Gynecol.,128, 448

  35. 35.

    HugginsG.R. and SuckerP.K. (1987). Oral contraceptives and neoplasia: 1987 update.Fertil. Steril.,47, 733

  36. 36.

    PikeM.C., HendersonB.E.S., KrailoM.D. et al. (1983). Breast cancer in young women and use of oral contraceptives: Possible modifying effect of formulation and age at use.Lancet,2, 926

  37. 37.

    McPhersonK., NeilA., VesseyM.P. et al. (1983). Oral contraceptives and breast cancer.Lancet,2, 1414

  38. 38.

    ClavelF., BenhamouE., Sitruk-VareR. et al. (1985). Breast cancer and oral contraceptives: A review.Contraception,32, 553

  39. 39.

    PaulC., SkeggD.C.G., SpearsC.F.S. et al. (1986). Oral contraceptives and breast cancer: A national study.Br. Med. J.,293, 723

  40. 40.

    Centers for Disease Control Cancer and Steroid Hormone Study (1986). Oral contraceptive use and the risk of breast cancer.N. Engl. J. Med.,315, 405

  41. 41.

    Chilvers, McPherson, Peto, Pike.Lancet, May 6, 1989

  42. 42.

    FDC Reports January 9, 1989, pp 13–14

  43. 43.

    MishellD.R. (1988). Use of oral contraceptives in women of older reproductive age.Am. J. Obstet. Gynecol.,158, 1652

  44. 44.

    AdamsM.R., ClarksonT.B., KoritnikD.R. et al. (1987). Contraceptive steroid and coronary artery atherosclerosis in cynomolgus macaques.Fertil. Steril.,47, 1010

Suggested reading

  1. 45.

    BrownK. and HammondC.B. (1989).Adv. Intern. Med.,34, 285

  2. 46.

    MishellD. (1989).N. Engl. J. Med.,320, 12

  3. 47.

    SkaggD.C. (1988).Am. J. Epidemiol.,127, 205

  4. 48.

    Supplement (1988).Am. J. Obstet. Gynecol., 158

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Additional information

This article was first published in theJournal of the Society of Obstetricians and Gynecologists of Canada, Volume 12, No. 1, pp. 9–15, January 1990, and is reprinted here by permission of the Society.

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Steinberg, W.M. Oral contraception: risks and benefits. Adv Contracept 5, 219–228 (1989). https://doi.org/10.1007/BF01890893

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Keywords

  • Public Health
  • Estrogen
  • Oral Contraceptive
  • Medical Community
  • Negative Aspect