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Combined oral contraceptives: do we know all of their effects?

Abstract：

:Combined oral contraceptives are undoubtedly popular. By the end of the 1980's, an estimated 63 million married women around the world were using this method of contraception. In Britain, perhaps 95% of all sexually active women have used the pill at some time before their 30th birthday. Commensurate with such widespread usage, huge amounts of money have been spent during the past 35 years investigating the health effects of this method of contraception. Since it appears that all of the potential risks and benefits have now been identified, can we divert resources from pill-related research into new areas of activity. While this proposition may be attractive to funding bodies, and other researchers competing for increasingly scarce resources, it ignores the fact that several major uncertainties remain concerning the safety of combined oral contraceptives. :Despite hundreds of research studies, definitive answers on the long-term health risks associated with combined oral contraceptives (OCs) remain elusive. There is general agreement that the adverse vascular effects of first-generation OCs containing 50 mcg or more of estrogen are not influenced by duration of use and do not persist once OC use is stopped. On the other hand, the pill's protective effect against endometrial and epithelial ovarian cancer is strengthened with prolonged use and persists after discontinuation. Less certain is the impact of long-term OC use by young, nulliparous women on breast cancer risk. Also in need of investigation is the association between pill use and cervical cancer--the most common malignancy among women in developing countries. As the first generation of OC users reaches the age where long-term effects become evident, these risks can be more definitively assessed. However, the risks associated with the new, low-dose OCs will remain uncertain for several decades. Of concern is the finding that users of low-dose OCs have a greater risk of breast cancer than users of the earlier, high-dose formulations. In addition, the new pills are less suppressive of plasma gonadotropin levels and ovarian activity, raising concerns about ovarian cancer risk. Given these uncertainties, continued funding for OC research is urged.

journal_name

Contraception

journal_title

Contraception

authors

Hannaford PC

doi

10.1016/0010-7824(95)00095-r

subject

Has Abstract

pub_date

1995-06-01 00:00:00

pages

325-7

issue

eissn

0010-7824

issn

1879-0518

pii

001078249500095R

journal_volume

pub_type

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Combined oral contraceptives: do we know all of their effects?