RISKS AND BENEFITS OF ORAL HORMONAL CONTRACEPTION

Abstract

Background: Oral hormonal contraception (OC) or the birth control pill that has been in use since 1960 is considered an efficient and reliable method of pregnancy prevention. In the early days the pill contained high doses of hormones, and the related complications were frequently reported. The composition of the pill has substantially changed, estrogen dose has been significantly decreased and so has the incidence of side effects.

Despite the reduced estrogen dose, the risk for the development of vein thromboembolism has not significantly decreased, as the final effect depends on the interaction with the progestage+n component. The OC use is in itself an independent risk factor for the develop- ment of ischemic stroke event (RR = 1.5), and for the development of myocardial infarction (RR = 1.84). Recent studies show that second generation OC users were at a higher risk of cardiovascular disease than the third generation OC users. The risk of breast cancer is also marginally increased (RR = 1.09-fold increased risk). The discussion about an association between the development of cervical cancer and an increased incidence of the disease in OC users is inclined to attribute this increased incidence to human papilloma virus infec- tion rather than to OC use. Beneficial effects of OC use are manifested through decreased incidence of endometrial cancer, which is mostly true in women with a lower body mass index (BMI). Additionally, OC plays a protective role in the development of ovarian cancer; recent studies have reported that OC use has prevented 200 000 ovarian cancers and 100 000 deaths from the disease. Also, the risk of colorectal cancer is OC users is lower (RR = 0.72).

Conclusions: Modern third generation OC preparations containing desogestrel and gestodene are a safe contraceptive method for all women except for those at increased risk of vein thrombosis.