Oral contraceptive use and benign gynecologic conditions. A review

Abstract

The following review considers the main epidemiologic data on oral contraceptives (OC) and the risk of major benign gynecologic diseases. Earlier studies investigating the relationship between OC use and functional ovarian cysts indicated that the use of high-dose combination OC have a protective effect, whereas low-dose monophasic or multiphasic pills have little or no effect. With regard to seromucinous cysts, the scanty data available are consistent with the notion of some protection of OC in current but not in former users, although possible effects of diagnostic and selection bias should be considered. Published data on the relationship between fibroids and OC appear too scattered to allow a precise quantification of risk. In any case, any relationship is moderate and, hence, of limited clinical and public health relevance. The data on OC and benign gynecologic conditions are reassuring in their absence of any consistent excess risk.

PIP: To clarify the association between oral contraceptives (OCs) and benign gynecologic conditions, a review was conducted of the epidemiologic literature on this relationship published in English since 1980. Use of earlier high-dose combined OCs has been shown to have a protective effect on functional ovarian cysts, presumably because of their high degree of ovarian suppression, but newer low-dose monophasic or multiphasic pills have little or no effect. Although studies are scarce, OCs appear to confer protection against seromucinous cysts in current but not former OC users. Published data on the possible association between OC use and endometriosis are conflicting, but any risk reduction appears to affect only current or recent OC users. Finally, findings on the association between uterine fibroids and OCs are too scattered to allow a precise quantification of risk; however, any such relationship is moderate and of limited clinical significance. Although epidemiologic analysis of OC use and benign gynecologic conditions is complicated by the potential for diagnostic and selection bias, the data as a whole are reassuring in their absence of evidence of any consistently excessive risk.