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    045351

    Oral contraceptives -- an overview.

    Shephard BD

    JOURNAL OF THE FLORIDA MEDICAL ASSOCIATION. 1986 Oct; 73(10):763-8.

    The increase in safety and public confidence in oral contraceptives (OCs) stems essentially from 3 factors: the availability of lower dose OCs, a better identification of risk factors, and more public awareness of noncontraceptive health benefits associated with OC use. The combination OC, used by 99% of women using OCs, continues to contain estrogen and progesterone in synthetic form, but the dosages and formulations have changed, giving the new pill a wider margin of safety. The OCs of today contain 1/5 the estrogen and 1/10 the progesterone as in the original OCs. During the decade of the 1980s, with estrogen dosage as low as therapeutically possible, medical research has shifted toward a more thorough evaluation of the progesterone component. In 1974 the Royal College of General Practitioners Study found a correlation between progesterone dosage and the frequency of high blood pressure developing in OC users. Subsequent studies reported that high blood pressure, which was likely to develop in about 5% of OC users on higher dose pill, will revert to normal when OC use is stopped. Additional research has linked pills containing progesterone in high dosages to elevations in blood sugar and blood cholesterol. Since progesterone dosage has declined from 10 milligrams in the original pill to 1 milligram or less in current formulations, there appears to be a wide margin of safety for most healthy young women using OCs. In the mid-1980s, further research on OCs has become more fine tuned with greater emphasis on how different types and combinations of hormones influence side effects and safety. The most recent development has been the introduction of "multiphasics" or sometimes called "triphasics." Multiphasic pills are basically low dose pills which vary hormone dosage in each of 3 separate phases in an effort to roughly simulate changes that would occur in a normal menstrual cycle. A better understanding of risk factors has increased markedly the margin of safety for women considering OC use. The report of the Alan Guttmacher Institute, "Making Choices," revealed that if women over 35 or who smoked did not use OCs, 86% of the approximately 500 pill-related deaths that occurred each year could be prevented. The Guttmacher report also attempted to quantify health benefits and risks to provide a more accurate overall picture of OC effects. Table 1 shows that many more hospitalizations are prevented than are caused by OC use. Among hospitalizations prevented, most were for benign breast disease, pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, ovarian cancer, and endometrial cancer. No evidence has linked defects or miscarriages to pregnancies conceived immediately after stopping OC use. The overall fertility of OC users and non-OC users is identical regardless of how long a woman uses OCs. A lack of consistent health education programs in the public schools has contributed in some instances to misinformation about OC and other contraceptive methods.
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