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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Progestins counteract the positive effect of the estrogen component in oral contraceptives (OCs) on cholesterol levels thus increasing the risk of atherosclerosis. Low androgenic potency progestins do not have a negative effect, however. Other research indicates that the lower the estrogen dose in OCs the lower the risk of deep vein and superficial thrombosis. OC users, especially low dose OC users, with no other risk factors (e.g. smoking and hypertension) are not at increased risk of cardiovascular disease. Some research demonstrates elevated risk of stroke in OC users, however. Elevated cholesterol, obesity, diabetes and other factors further increases the risk of stroke. Combined OCs protect against endometrial and ovarian cancer and this effect increases with use and continues after use. Moreover OC users are not at increased risk of pituitary adenoma. Results of some studies shows an increased risk of cervical cancer, but other only demonstrates a slight increase. So far research does not indicate the following to increase breast cancer risk among OC users: early age at 1st OC use, formulation, family history, and history of benign breast disease. There is an increased risk for liver tumors in OC users, nevertheless it is rare. OCs do not raise the risk of diabetes or gallbladder disease. High dose formulations increases the risk of high blood pressure, but not so with low dose formulations. OC use does not impair, fertility, but delayed conception often occurs. Most research demonstrates no increase in pelvic inflammatory disease in OC users. OCs do not cause congenital malformations. Combined OC use is contraindicated for breast feeding mothers, but progestin only OCs can be used with no advance effects. Results of 1 study demonstrates an increase in HIV infection in OC users, but another study has opposite results. The article concludes with recommended clinical management practices.
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PMID:Reassessment of the metabolic effects of oral contraceptives. 185 68

The overall risk of oral contraceptive (OC) use is minimal when women over 35 years of age, smokers, and those with multiple risk factors (thromboembolic disorders, cerebrovascular or coronary artery disease, liver tumors, breast cancer, estrogen-dependent neoplasms, undiagnosed abnormal genital bleeding, and congenital hyperlipidemia) are excluded. OC use increases the risk of hypertension by 1-5%, depending on age, parity, and duration of use, but even this small risk is decreased when multiphasic OCs are prescribed. Deep venous thrombosis in the leg is 4 times more prevalent in OC users than nonusers and the risk of superficial thrombosis is doubled. Again, fewer thromboembolic complications occur when the estrogen dosage is low. The risk of myocardial infarction is not believed to increase with OC use as long as other risk factors--smoking, obesity, hypertension, age over 35 years, hypercholesterolemia--are not present. Studies involving the original high-dose OCs revealed a 3-fold increase in the risk of thrombotic stroke and a 2-fold increase in the risk of hemorrhagic stroke, but low-dose OCs appear to have no effect on the potential for stroke. The impact of OC use on breast cancer cannot yet be determined given the very long latency period of this cancer. In terms of benign breast disease, OC users have been shown to be at substantially reduced risk of lesions, fibroadenomas, and fibrocystic changes. OCs also protect women from endometrial and ovarian cancer, although the pill seems to accelerate the progression of cervical dysplasia. Other beneficial effects of OC use include reductions in the incidence of pelvic inflammatory disease, endometriosis, ectopic pregnancy, and ovarian cysts.
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PMID:Oral contraceptive pills. Part II: Potential complications and health benefits. 228 19

Like all drugs, combined oral contraceptives (COCs) have side effects that may be harmful or beneficial. During the last 20 years their adverse effects have been fully reported, but their benefits have been largely ignored. Most of the benefits of COCs result from the suppression of ovulation. This means that the advantages they confer are not dose-dependent, provided that ovarian activity is effectively suppressed. The most important health benefit of COCs worldwide is the effective prevention of pregnancy, which carries high risks in developing countries and has a mortality as high as 1 in 150 in Africa. The risk of ectopic pregnancy is reduced by 90% in COC-users compared with women using no contraception. The COC prevents the repeated proliferation of ovarian and endometrial tissue that takes place in the menstrual cycle, and it is therefore not surprising that it reduces the risk of ovarian and endometrial malignancy. What is surprising is that a relative risk of 0.6 for these cancers can be detected after only 12 months or less of COC use, and persists for at least 15 years after the COC is stopped. The COC reduces the incidence of benign breast disease, though not the types of disease linked with breast cancer. It considerably reduces the incidence of benign ovarian cysts, and this has been calculated to avoid 28 operations for functional ovarian cysts per 100,000 pill users every year. The risk of uterine fibroids is reduced by 17% with every five years of COC use. By thickening the cervical mucus, the COC reduces the risk of pelvic inflammatory disease by about 50%. By inhibiting growth and development of the endometrium it reduces the incidence of menorrhagia and consequently iron-deficiency anaemia, and it produces a 40% reduction in the frequency of dysmenorrhoea. Unlike the benefits of the COC, its risks appear to be to some extent dose-dependent. The first serious risk to be discovered was a three- to six-fold increase in venous thromboembolism, which is probably an oestrogen effect and disappears quickly when the COC is stopped. The COC doubles the risk of haemorrhagic stroke, this risk is related to smoking and hypertension, unlike the increased risk of thrombotic stroke. The risk of myocardial infarction is related to smoking and age, and COCs are contraindicated over the age of 35 in smokers though not necessarily in non-smokers. Much of this information, however, is based on studies involving older high-dose COCs. Risks may well be lower with modern COCs, but firm data are lacking.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Benefits and risks of oral contraceptives. 229 44

This report combines early and late mortality effects of oral contraceptives into a life table analysis based on epidemiological evidence using US data. An association between oral contraceptives and disease is included only if demonstrated by at least 2 previous independent studies; those included in the study are: pregnancy complications, cancer (ovarian, endometrial, cervical), cardiovascular disease, gallbladder disease, pelvic inflammatory disease, and rheumatoid arthritis. The model assumes women who use oral contraceptives continuously for 5 years and then stop, and compares this with a base population of US women aged 15-49 who are not using oral contraceptives. Results drawn from these data are that oral contraceptives taken for 5 years have no effect on life expectancy of women under 30; 5 years of use during the 30's reduces average life expectancy by 7-22 days; and among older women (over 40) life expectancy decreases up to 88 days. Protective effects of oral contraceptives against reproductive cancers cancels out risks due to myocardial infarction and stroke. This model does not account for different risks of smokers and non-smokers, therefore the small differences in longevity are probably exaggerated. The decreased life expectancy is due mainly to the increased mortality from myocardial infarction and stroke. This is substantially less than life lost due to use of a variety of other substances, most notably tobacco.
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PMID:Oral contraceptives and life expectancy. 352 49

During the 20 years since the oral contraceptive was introduced, it has been used by some 150 million women around the world, and is perhaps the most carefully monitored medication in history. This vast body of research shows that for the overwhelming majority of healthy women under 30, the benefits of the pill continue to outweigh the risks. The most serious life threatening risks are those involving the cardiovascular system: heart attack, stroke, and throboembolism. However, deaths from these causes would be reduced by 1/2 if women using the pill did not smoke; further reductions would result if women with high blood pressure, high chloresterol levels and diabetes millitus did not use the pill. There is no evidence thus far to justify fears that the pill might be associated with an increased risk of cancer. Most studies show that not only is there no association between pill use and cancer of the ovaries, uterus and breast, but pill use may protect against ovarian and endometrial cancer. Women taking the pill are 1/4 as likely to develop benign breast lumps as nonusers, 1/14 as likely to develop ovarian cysts, 2/3 as likely to develop iron deficiency anemia, and 1/2 as likely to develop rheumatoid arthritis -- all relatively common conditions. In addition, pelvic inflammatory disease, a major cause of infertility, appears to occur only 1/2 as often among pill users as among nonusers. The risk to life among pill users younger than 30 who do not smoke is very small (virtually the same as that of users of the IUD, diaphragm, or condom) and is much lower than the risk of birth-related deaths among women who use no birth control.
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PMID:The pill at 20: an assessment. 720 90

The use of combined oral contraceptives carries a number of well-established major non-contraceptive benefits. Of these, the most important protective effects are suppression of the risk of epithelial cancer of the ovary and cancer of the endometrium. Also of great importance is a reduction in the risk of pelvic inflammatory disease. Needless to say, there are also some established risks of combined oral contraceptives. The most important of these are the vascular ones, comprising effects on acute myocardial infarction, thrombotic stroke, haemorrhagic stroke, and venous thrombosis and embolism. Possible risks which are still under evaluation include an adverse effect on breast cancer and, likewise, on carcinoma of the cervix. More information is needed about both these conditions. A number of authors have provided analyses of varying degrees of complexity in which they have attempted to weigh the benefits and risks of combined oral contraceptives. Results from some of these studies are presented in the paper. On the whole, the findings are reasonably reassuring.
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PMID:Benefits and risks of combined oral contraceptives. 834 Nov 54

Women with many medical conditions need to plan their families with special care. For such women, the risk of complications with particular contraceptive methods is increased. Women with severe hypertension, a previous myocardial infarction or venous thromboembolism, or cerebrovascular stroke have a significant risk of problems in pregnancy, and should avoid the combined pill. The combined pill may increase the risk of cardiovascular disease in patients with diabetes mellitus and may worsen the severity of migrainous headaches in susceptible patients. Women with active hepatitis should wait for liver function tests to normalise before becoming pregnant or starting the combined pill or injectable progestogen. Control of epilepsy may deteriorate with use of the combined pill; this is probably because of the risk of drug interactions. Similarly, contraceptive control may also fail in women receiving rifampicin (rifampin) concurrently with contraceptive steroids. Intrauterine contraceptive devices should not be used in women who have experienced previous episodes of pelvic inflammatory disease, or with previous malignancy of the genital tract until complete cure is likely. Other conditions which may appear, become more common or worsen when the combined pill is prescribed include hepatic adenoma, gall bladder disease, ulcerative colitis, alopecia, hirsutism and acne. Some of these conditions are potentially hazardous to the woman's health, in which case combined pill use should be stopped. If the condition is unchanged then the combined pill may sometimes be reintroduced with caution.
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PMID:Contraceptive choice for women with 'risk factors'. 848 Dec 14

People are so conscious of the possible risks involved in using contraceptives that they sometimes overlook the many benefits of contraceptive use for most women. Most women have only minimal risk factors from contraceptive use and can safely choose from all available contraceptives. There are, however, some women for whom pre-existing medical conditions may increase the risk factors associated with using certain contraceptives. Recommendations are given for safely prescribing for patients with some of the more common problems associated with contraceptive use. The following conditions are considered: insulin-dependent diabetes mellitus, epilepsy, hypertension, migraine headaches, sickle-cell disease, personal or family history of venous thromboembolism, personal or family history of heart disease or stroke, personal or family history of carcinoma of the breast, and pelvic inflammatory disease and ectopic pregnancy.
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PMID:Action plans for safe prescribing. 992 92

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life.
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PMID:Current perspectives on oral contraceptive use. 1152 Nov 17

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73


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