Title: The benefits and risks of hormonal contraceptives: an epidemiologist's view.

POPLINE Document Number: 077311

Author(s):

Irwin KL

Source citation:

In: Fertility regulation today and tomorrow, [edited by] E. Diczfalusy and M. Bygdeman. New York, New York, Raven Press, 1987. :205-15. (Serono Symposia Publications from Raven Press, Volume 36)

Abstract:

Epidemiologic studies over the past 25 years have identified several benefits and risks of hormonal contraception. The short and long-term health effects of oral contraceptives, the most widely used hormonal contraceptive, have been studied in detail since their introduction in the early 1960s. Oral contraceptives are currently used by more than 50 million women worldwide. 1 of the reasons for the Pill's popularity is its high effectiveness, with an annual pregnancy rate of less than 1%. Oral contraceptive (OC) use may produce lighter and more regular periods and relief from dysmenorrhea and premenstrual tension. It may substantially reduce menstrual blood loss and protect against iron-deficiency anemia. OCs also protect against severe pelvic inflammatory disease, benign breast disease, and a may result in a reduced risk of developing ovarian and endometrial cancer. However, a number of studies suggest that OCs may increase the risk of lower genital tract chlamydial infection. Other widely proclaimed risks are those associated with circulatory system disease. Thromboembolism, ischemic heart disease, myocardial infarction, cerebrovascular disease, and hypertension continue to be a major cause of Pill-associated morbidity and mortality. OCs may increase cardiovascular disease risks by altering blood coagulation systems, serum cholesterol, blood pressure, or cardiac output. About 4 million women in more than 100 countries currently use the 2 available long-acting injectable contraceptives, depot medroxyprogesterone acetate (DMPA) and norethindrone enanthate. Both have a pregnancy rate of less than 1%. They may cause oligomenorrhea and amenorrhea, which may protect against iron deficiency anemia. Injectables may also decrease the risk of severe acute pelvic infection. They do not appear to reduce the duration or volume of lactation, as combination OCs might. However, menstrual irregularities resulting from injectables may be regarded as disadvantages. They may also be associated with a slightly delayed return of fertility. Compared with users of OCs or IUDs, former users of DMPA require an average of 1-3 months longer to conceive after the contraceptive effect has ceased. Evidence that other high-dose progestins might harm the fetus raised concerns that injectable progestins might cause teratogenic effects if used during pregnancy, though no case reports show excess risk of congenital malformations or prematurity. Remarkably few metabolic changes have been reported in users of injectables. Whether long-acting injectables affect the risks of cancer is a continuing source of controversy that calls for further study.

Keywords:

Developing Countries
Developed Countries
Oral Contraceptives, Side Effects
Obstacles
Oral Contraceptives
Injectables
Research and Development
Side Effects
Contraceptive Safety
Safety
Public Health
Health
Organization and Administration
Contraceptive Methods
Contraception
Family Planning
Technology
Economic Factors
Treatment