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Benefits and risks of oral contraception 

Benefits and risks of oral contraception

Benefits and risks of oral contraception

John Guillebaud


November 28, 2012: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 28 April 2017

Efficacy of the ‘pill’ as an oral contraceptive—users of combined oral contraceptives (COC) must understand the importance of not lengthening the pill-free (contraception-deficient) time, and be appropriately advised if prescribed enzyme-inducing drugs.

Noncontraceptive benefits of COC use—these include fewer disorders of the menstrual cycle and less risk of colorectal cancer and cancers of the ovary and endometrium, which may sometimes provide the principal indication for prescription.

Risks of COC use—these include (1) cancer of the breast (possible cofactor) and of the cervix (probable cofactor, with impact reducible through cervical screening); (2) venous thromboembolism—the attributable risk with any formulation of COC is very small without a hereditary or acquired predisposition, including obesity and immobility; (3) vascular diseases—the attributable risk of both acute myocardial infarction and haemorrhagic stroke is negligible without an added arterial risk factor; migraine with aura is a specific thrombotic stroke risk factor and contraindicates use of any oestrogen-containing method of contraception. By 10 years all-cause mortality in past-users is indistinguishable from that in never-users of the COC.

Progestogen-only pills—these have fewer contraindications than COC. Desogestrel 75 μ‎g (Cerazette) blocks ovulation in 97% of cycles, hence it relies less than other progestogen-only pills on the cervical mucus effect and is a more effective option if COC is contraindicated.

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