Benefits and risks of oral contraceptives

Abstract

The major benefits of modern low-dose oral contraceptives include relative safety and a high degree of efficacy, decreasing the need for abortion or surgical sterilization; reduced risks of bacterial (but not viral) pelvic inflammatory disease and of endometrial and ovarian cancer; improved menstrual regularity, with less dysmenorrhea and blood flow; and, when low-dose combination (not progestogen-only) oral contraceptives are used, reduced acne and hirsutism. Major risks are cardiovascular. Preliminary data from nonrandomized studies suggest that oral contraceptives containing third-generation progestogens are associated with increased risk of venous thromboembolism, particularly in carriers of the coagulation factor V Leiden mutation. The risk of arterial thrombosis, such as myocardial infarction or stroke, may be directly related to estrogen dose, particularly in women who have hypertension, smoke, or are >35 years old. Considering that only users aged >/=30 years who smoke >/=25 cigarettes/d have a higher estimated mortality rate than that of pregnant women, the benefits of oral contraceptives appear to outweigh their risks.

PIP: This article presents the benefits and risks of low-dose oral contraceptives (OCs). Most OCs contain a low-dose combination of ethinyl estradiol (or= 35 mcg) and a progestogen (0.1-1.5 mg, depending on the product type). OCs are relatively safe and effective when used for years; they control fertility in women and facilitate spontaneous sexual activity. Other benefits include: 1) improvement in the regularity of menses; 2) decrease in the incidence of dysmenorrhea; 3) circulation of blood flow; 4) reduction of the risks of ovarian and endometrial cancer; 5) inhibition of rheumatoid arthritis progression from mild to severe; and 6) when using low-dose combination (not progestogen-only) OCs, acne and hirsutism are reduced. However, there are also risks in using OCs. The risks associated with OC use are mostly cardiovascular. OCs containing third-generation progestogens are linked with an increased risk of venous thromboembolism. Moreover, acute myocardial infarction risk is great among smokers with hypertension, particularly among women older than 35 years; however, the risk decreases as the dosage of ethinyl estradiol decreases.