Oral Contraceptives: An Update on Health Benefits and Risks
Oral Contraceptives: An Update on Health Benefits and Risks
Objective. To review the health benefits and risks of oral contraceptives, with an emphasis on emerging noncontraceptive benefits and the pharmacist's role in promoting safe and effective use of these widely prescribed medications.
Data Sources. Published articles identified through MEDLINE (1995-2001) using the search terms oral contraception, neoplasms, cardiovascular disease, menstrual cycle, and other pertinent subject headings. Additional articles and books were identified from the bibliographies of the retrieved articles.
Data Synthesis. Combined oral contraceptives (COCs), which contain synthetic estrogen and progestin, are the second most common form of birth control for women after sterilization. When taken properly, COCs are highly effective, with a pregnancy rate of 0.1% among perfect users. Also, a growing body of evidence points to multiple noncontraceptive benefits of COCs, including protection from several types of cancer and a variety of gynecologic benefits, such as reduced menstrual bleeding irregularities and fewer ectopic pregnancies. COCs are one of the most studied classes of medications, and they have been found to have an excellent safety profile in nonsmoking healthy women. They may be used continuously until menopause. For women with coexisting medical conditions or other special circumstances, the risks and benefits of COCs must be carefully evaluated before use.
Conclusion. More than 40 years after their introduction, COCs remain the leading form of hormonal contraception. By assessing patients' contraceptive needs, evaluating their risk factors, and providing sensitive and thorough counseling, pharmacists can help ensure the safe and effective use of these medications.
More than 40 years have passed since the introduction of combined oral contraceptives (COCs) in the United States. These medications have become an integral part of birth control and remain the second most common contraceptive option for women after sterilization. More than 10 million of the 60 million American women currently in their childbearing years have chosen "the pill" as their preferred method of contraception.
COCs provide the contraceptive benefits of safety, high efficacy, and rapid reversibility. In addition, a substantial and growing body of evidence points to numerous noncontraceptive benefits of COCs, although most women are unaware of these additional health advantages. Accumulating evidence is also illuminating the potential risks of COC use in women with certain coexisting medical conditions or other specific circumstances. As health care professionals who frequently encounter women of reproductive age women, pharmacists have a critical role in promoting the safe and effective use of these medications.
This article provides an update on the health benefits and risks of COCs, summarizing new or emerging noncontraceptive uses of these medications and reviewing important topics for patient education and counseling.
Abstract
Objective. To review the health benefits and risks of oral contraceptives, with an emphasis on emerging noncontraceptive benefits and the pharmacist's role in promoting safe and effective use of these widely prescribed medications.
Data Sources. Published articles identified through MEDLINE (1995-2001) using the search terms oral contraception, neoplasms, cardiovascular disease, menstrual cycle, and other pertinent subject headings. Additional articles and books were identified from the bibliographies of the retrieved articles.
Data Synthesis. Combined oral contraceptives (COCs), which contain synthetic estrogen and progestin, are the second most common form of birth control for women after sterilization. When taken properly, COCs are highly effective, with a pregnancy rate of 0.1% among perfect users. Also, a growing body of evidence points to multiple noncontraceptive benefits of COCs, including protection from several types of cancer and a variety of gynecologic benefits, such as reduced menstrual bleeding irregularities and fewer ectopic pregnancies. COCs are one of the most studied classes of medications, and they have been found to have an excellent safety profile in nonsmoking healthy women. They may be used continuously until menopause. For women with coexisting medical conditions or other special circumstances, the risks and benefits of COCs must be carefully evaluated before use.
Conclusion. More than 40 years after their introduction, COCs remain the leading form of hormonal contraception. By assessing patients' contraceptive needs, evaluating their risk factors, and providing sensitive and thorough counseling, pharmacists can help ensure the safe and effective use of these medications.
Introduction
More than 40 years have passed since the introduction of combined oral contraceptives (COCs) in the United States. These medications have become an integral part of birth control and remain the second most common contraceptive option for women after sterilization. More than 10 million of the 60 million American women currently in their childbearing years have chosen "the pill" as their preferred method of contraception.
COCs provide the contraceptive benefits of safety, high efficacy, and rapid reversibility. In addition, a substantial and growing body of evidence points to numerous noncontraceptive benefits of COCs, although most women are unaware of these additional health advantages. Accumulating evidence is also illuminating the potential risks of COC use in women with certain coexisting medical conditions or other specific circumstances. As health care professionals who frequently encounter women of reproductive age women, pharmacists have a critical role in promoting the safe and effective use of these medications.
This article provides an update on the health benefits and risks of COCs, summarizing new or emerging noncontraceptive uses of these medications and reviewing important topics for patient education and counseling.
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