Drug Safety

, Volume 12, Issue 2, pp 91–96 | Cite as

The Combined Oral Contraceptive

Risks and Adverse Effects in Perspective
  • Sue Bagshaw


The risks and adverse effects of the low dose, new generation progestogen combined oral contraceptives (COCs) are much lower than original studies involving pills containing 50µg estrogen. The main effects are those on the cardiovascular system, lipid and glucose metabolism and cancer.

Any effect of the COC on myocardial infarction is probably minimal if the woman has no other risk factors especially smoking. The third generation progestogen, low dose COCs have very little effect on lipid or glucose metabolism.

There may be a slight increase in breast cancer if COCs are used under the age of 25 years and for more than 4 to 8 years, and in the risk of cervical cancer. It is too early to estimate long term cancer effects of the newer COCs.

Adverse effects such as nausea and breast tenderness can be managed by changing the estrogen dose or the type of progestogen.

Overall, the clinical benefits of the COC probably outweigh the risks and adverse effects.


Adis International Limited Myocardial Infarc Combine Oral Contraceptive Breast Tenderness Estrogen Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Guillebaud J. The pill. 3rd ed. Oxford: Oxford University Press, 1984Google Scholar
  2. 2.
    Bottiger LE, Bowman G, Eklund G, et al. Oral contraceptives and thromboembolic disease: effects of lowering oestrogen content. Lancet 1980; 8178: 1097–101CrossRefGoogle Scholar
  3. 3.
    Lidegaafd O. Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study. BMJ 1993; 306: 956–63CrossRefGoogle Scholar
  4. 4.
    Royal College of General Practitioners’ Oral Contraception Study. Incidence of arterial disease among oral contraceptive users. J R Coll Gen Pract 1983; 33: 75–82Google Scholar
  5. 5.
    Thorogood M, Mann J, Murphy M, et al. Is oral contraceptive use still associated with an increased risk of fatal myocardial infarction? Report of a case-control study. Br J Obstet Gynaecol 1991; 98: 1245–53PubMedCrossRefGoogle Scholar
  6. 6.
    Drife J. Complications of combined oral contraception. In: Filshie M, Guillebaud J, editors. Contraception: science and practice. London: Butterworth, 1989: 39–51Google Scholar
  7. 7.
    Godsland I, Crook D, Wynn V. Clinical and metabolic considerations of long-term oral contraceptive use. Am J Obstet Gynecol 1992; 166: 1955–63PubMedGoogle Scholar
  8. 8.
    Rushton L, Jones D. Oral contraceptive use and breast cancer risk: a metaanalysis of variations with age at diagnosis, parity and total duration of oral contraceptive use. Br J Obstet Gynaecol 1992; 99: 239–46PubMedCrossRefGoogle Scholar
  9. 9.
    Vessey M. Oral contraception and cancer. In: Filshie M, Guillebaud J, editors. Contraception: science and practice. London: Butterworth, 1989: 51–68Google Scholar
  10. 10.
    World Health Organization collaborative study of neoplasia and steroid contraceptives. Combined oral contraceptives and liver cancer. Int J Cancer 1989; 43: 69–93Google Scholar
  11. 11.
    Vessey MP, Smith MA, Yeates D. Return of fertility after discontinuation of oral contraceptives: influence of age and parity. Br J Family Plan 1986; 11: 120–4Google Scholar
  12. 12.
    Bracken MB, Hellenbrand KG, Holford TR. Conception delay after oral contraceptive use: the effect of estrogen dose. Fertil Steril 1990 Feb; 53: 21–7PubMedGoogle Scholar
  13. 13.
    Guillebaud J. Practical prescribing of the combined oral contraceptive pill. In: Filshie M, Guillebaud J, editors. Contraception: science and practice. London: Butterworth, 1989: 69–93Google Scholar
  14. 14.
    Baird D, Glasier A. Drug therapy review article. Hormonal contraception. N Engl J Med 1993; 328: 1543–9PubMedCrossRefGoogle Scholar
  15. 15.
    Grimes D. The safety of oral contraceptives: epidemiologic insights from the first 30 years. Am J Obstet Gynecol 1992; 166: 1950–4PubMedGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Sue Bagshaw
    • 1
  1. 1.Manager Medical ServicesNew Zealand Family Planning Association, Southern RegionChristchurchNew Zealand

Personalised recommendations