Oral contraceptive side effects: where's the beef?

Abstract

The initial report is reviewed, as well as the results of subsequent investigations, and the current status of the following side effects attributed to the use of oral contraceptives: subjective symptoms such as mood and libido changes, also headache; melanoma; gallbladder disease; liver tumors, sickle cell disease exacerbation; teratogenesis; "post-Pill" amenorrhea; atherogenesis; and diminished carbohydrate tolerance. In many instances a cause-and-effect relationship appears to be incorrect or highly improbable. In other instances the side effects are clinically insignificant or so rare as to be of minimal importance. Yet they continue to be listed by various authorities as validated side effects or relative contraindications to oral contraceptive use. This, in turn, limits the access of many women to a highly effective form of contraception. This re-examination of past history is intended to modernize our concepts of the safety of this modality.

PIP: The authors review the evidence regarding a number of important adverse reactions attributed to oral contraceptive (OC) use, identify the original claim and subsequent documentation, and form a current opinion on the validity of existing claims. This examination was conducted in hopes of modernizing concepts on the safety of OC use. Mood and libido changes, as well as headache; melanoma; gallbladder disease; liver tumors; the exacerbation of sickle cell disease; teratogenesis; "post-Pill" amenorrhea; atherogenesis; and diminished carbohydrate tolerance have been attributed as side effects related to the use of OCs. A cause-and-effect relationship, however, in many instances appears to be false or highly unlikely. In other instances, the side effects are clinically insignificant or so rare as to be of minimal importance. These side effects nonetheless continue to be listed by various authorities as valid or relative contraindications to OC use. Such indications only limit the access of many women to this highly effective form of contraception.