Download PDF
Semin Reprod Med 2001; 19(4): 295-304
DOI: 10.1055/s-2001-18637
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Noncontraceptive Benefits and Therapeutic Uses of the Oral Contraceptive Pill

Molina Dayal, Kurt T. Barnhart
  • Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
29 November 2001 (online)

   Permissions and Reprints

ABSTRACT

The oral contraceptive pill is one of the most extensively studied medications ever prescribed. The health benefits are numerous and outweigh the risks of their use. Definitive evidence exists for protection against ovarian and endometrial cancers, benign breast disease, pelvic inflammatory disease requiring hospitalization, ectopic pregnancy, and iron-deficiency anemia. It has also been suggested that oral contraceptives may provide a benefit on bone mineral density, uterine fibroids, toxic shock syndrome, and colorectal cancer. Minimal supportive evidence exists for oral contraceptives protecting against the development of functional ovarian cysts and rheumatoid arthritis. Treatment of medical disorders with oral contraceptives is an ``off-label'' practice. Dysmenorrhea, irregular or excessive bleeding, acne, hirsuitism, and endometriosis-associated pain are common targets for oral contraceptive therapy. Most patients are unaware of these health benefits and therapeutic uses of oral contraceptives, and they tend to overestimate their risk. Counseling and education are necessary to help women make well-informed health-care decisions and improve compliance.

KEYWORD

Noncontraceptive benefits - therapeutic uses - oral contraceptive pills - combination OCP

REFERENCES

  • 1 The Gallup Organization. Attitudes toward contraception: a poll conducted for the American College of Obstetricians and Gynecologists Princeton, NJ: March 1985
  • 2 American College of Obstetricians and Gynecologists. Poll shows women still skeptical of contraceptive safety (press release) Washington, DC: ACOG; January 20 1994
  • 3 Peipert J F, Gutmann J. Oral contraceptive risk assessment: a survey of 247 educated women.  Obstet Gynecol . 1993;  82 112-117
    PubMedSearch in Google Scholar
  • 4 Schlesselman J J. Cancer of the breast and reproductive tract in relation to use of oral contraceptives.  Contraception . 1989;  40 1-38
    CrossrefPubMedSearch in Google Scholar
  • 5 The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral contraceptive use.  N Engl J Med . 1987;  316 650-655
    PubMedSearch in Google Scholar
  • 6 Schlesselman J J. Net effect of oral contraceptive use on the risk of cancer in women in the United States.  Obstet Gynecol . 1995;  85 793-801
    CrossrefPubMedSearch in Google Scholar
  • 7 Ness R B, Grisso J A, Cottreau C. Factors related to inflammation of the ovarian epithelium and risk of ovarian cancer.  Epidemiology . 2000;  11 111-117
    CrossrefPubMedSearch in Google Scholar
  • 8 Narod S A, Risch H, Moslehi R. Oral contraceptives and the risk of hereditary ovarian cancer.  N Engl J Med . 1998;  339 424-428
    CrossrefPubMedSearch in Google Scholar
  • 9 Gross T P, Schlesselman J J. The estimated effect of oral contraceptive use on the cumulative risk of epithelial ovarian cancer.  Obstet Gynecol . 1994;  83 419-422
    PubMedSearch in Google Scholar
  • 10 Prentice R L, Thomas D B. On the epidemiology of oral contraceptives and disease.  Adv Cancer Res . 1987;  49 285-401
    PubMedSearch in Google Scholar
  • 11 Schlesselman J J. Oral contraceptives and neoplasia of the uterine corpus.  Contraception . 1991;  43 557-579
    CrossrefPubMedSearch in Google Scholar
  • 12 The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. Combination oral contraceptive use and the risk of endometrial cancer.  JAMA . 1987;  257 796-800
    CrossrefPubMedSearch in Google Scholar
  • 13 Rosenblatt K A, Thomas D B, the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Hormonal content of combined oral contraceptives in relation to the reduced risk of endometrial carcinoma.  Int J Cancer . 1991;  49 870-874
    PubMedSearch in Google Scholar
  • 14 Mishell Jr R D. Noncontraceptive benefits of oral contraceptives.  J Reprod Med . 1993;  38 1021-1029
    PubMedSearch in Google Scholar
  • 15 Peterson H B, Lee N C. The health effects of oral contraceptives: misperceptions, controversies, and continuing good news.  Clin Obstet Gynecol . 1989;  32 339-355
    PubMedSearch in Google Scholar
  • 16 Ory H W. The noncontraceptive health benefits from oral contraceptive use.  Fam Plan Perspect . 1982;  14 182-184
    PubMedSearch in Google Scholar
  • 17 Royal College of General Practitioners' Oral Contraception Study. Effect on hypertension and benign breast disease of progestagen component in combined oral contraceptives.  Lancet . 1977;  1 624
    PubMedSearch in Google Scholar
  • 18 Brinton L A, Vessey M P, Flavel R. Risk factors for benign breast disease.  Am J Epidemiol . 1981;  113 203-214
    PubMedSearch in Google Scholar
  • 19 Mishell Jr R D. Noncontraceptive health benefits of oral steroidal contraceptives.  Am J Obstet Gynecol . 1982;  142 809-816
    PubMedSearch in Google Scholar
  • 20 Rubin G L, Ory H W, Layde P M. Oral contraceptives and pelvic inflammatory disease.  Am J Obstet Gynecol . 1982;  144 630-635
    PubMedSearch in Google Scholar
  • 21 Wolner-Hanssen P, Svensson L, Mardh P. Laparoscopic findings and contraceptive use in women with signs and symptoms suggestive of acute salpingitis.  Obstet Gynecol . 1985;  66 233-238
    PubMedSearch in Google Scholar
  • 22 Wolner-Hanssen P, Eschenbach D A, Paavonen J. Decreased risk of symptomatic chlamydial pelvic inflammatory disease associated with oral contraceptive use.  JAMA . 1990;  263 54-59
    CrossrefPubMedSearch in Google Scholar
  • 23 Eschenbach D A, Harnisch J P, Holmes K K. Pathogenesis of acute pelvic inflammatory disease: role of contraception and other risk factors.  Am J Obstet Gynecol . 1977;  128 838-850
    PubMedSearch in Google Scholar
  • 24 Wolner-Hannsen P. Oral contraceptive use modifies the manifestations of pelvic inflammatory disease.  Br J Obstet Gynaecol . 1986;  93 619-624
    PubMedSearch in Google Scholar
  • 25 Panser L A, Phipps W R. Type of oral contraceptive in relation to acute, initial episodes of pelvic inflammatory disease.  Contraception . 1991;  43 91-99
    CrossrefPubMedSearch in Google Scholar
  • 26 Svensson L, Westrom L, Mardh P. Contraceptives and acute salpingitis.  JAMA . 1984;  251 2553-2555
    CrossrefPubMedSearch in Google Scholar
  • 27 Franks A L, Beral V, Cates Jr W. Contraception and ectopic pregnancy risk.  Am J Obstet Gynecol . 1990;  163 1120-1123
    PubMedSearch in Google Scholar
  • 28 Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception.  Obstet Gynecol . 1991;  78 291-298
    PubMedSearch in Google Scholar
  • 29 Sivin I. International experience with NORPLANT and NORPLANT-2 contraceptives.  Stud Fam Plann . 1988;  19 81-94
    PubMedSearch in Google Scholar
  • 30 Vessey M, Metcalfe A, Wells C. Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.  BMJ . 1987;  294 1518-1520
    PubMedSearch in Google Scholar
  • 31 Holt V L, Daling J R, McKnight B. Functional ovarian cysts in relation to the use of monophasic and triphasic oral contraceptives.  Obstet Gynecol . 1992;  79 529-533
    PubMedSearch in Google Scholar
  • 32 Lanes S F, Birmann B, Walker A M, Singer S. Oral contraceptive type and functional ovarian cysts.  Am J Obstet Gynecol . 1992;  166 956-961
    PubMedSearch in Google Scholar
  • 33 Kleerekoper M, Brienza R S, Schultz L R. Oral contraceptive use may protect against low bone mass.  Arch Intern Med . 1991;  151 1971-1976
    CrossrefPubMedSearch in Google Scholar
  • 34 Cooper C, Hannaford P, Croft P. Oral contraceptive pill use and fractures in women: a prospective study.  Bone . 1993;  14 41-45
    CrossrefPubMedSearch in Google Scholar
  • 35 Vessey M, Mant J, Painter R. Oral contraception and other factors in relation to hospital referral for fracture: findings in a large cohort study.  Contraception . 1998;  57 231-235
    CrossrefPubMedSearch in Google Scholar
  • 36 Michaëlsson K, Baron J A, Farahmand B Y. Oral contraceptive use and risk of hip fracture: a case-control study.  Lancet . 1999;  353 1481-1484
    CrossrefPubMedSearch in Google Scholar
  • 37 Hall M L, Heavens J, Cullum I D, Ell P J. The range of bone density in normal British women.  Br J Radiol . 1990;  63 266-269
    PubMedSearch in Google Scholar
  • 38 Mazess R B, Barden H S. Bone density in premenopausal women: effects of age, dietary intake, physical activity, smoking and birth control pills.  Am J Clin Nutr . 1991;  53 132-142
    PubMedSearch in Google Scholar
  • 39 DeCherney A. Bone-sparing properties of oral contraceptives.  Am J Obstet Gynecol . 1996;  174 15-20
    PubMedSearch in Google Scholar
  • 40 Potter J D, McMichael A J. Large bowel cancer in women in relation to reproductive and hormonal factors: a case-control study.  J Natl Cancer Inst . 1983;  71 703-709
    PubMedSearch in Google Scholar
  • 41 Furner S E, Davis F G, Nelson R L. A case-control study of large bowel cancer and hormone exposure in women.  Cancer Res . 1989;  49 4936-4940
    PubMedSearch in Google Scholar
  • 42 Kune G A, Kune S, Watson L F. Oral contraceptive use does not protect against large bowel cancer.  Contraception . 1990;  41 19-25
    CrossrefPubMedSearch in Google Scholar
  • 43 Weiss N S, Daling J R, Chow W H. Incidence of cancer of the large bowel in women in relation to reproductive and hormonal factors.  J Natl Cancer Inst . 1981;  67 57-60
    PubMedSearch in Google Scholar
  • 44 Bostick R M, Potter J D, Kushi L H. Sugar, meat, fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States).  Cancer Causes Control . 1994;  5 38-52
    CrossrefPubMedSearch in Google Scholar
  • 45 Fernandez E, La Vecchia C, Balducci A. Oral contraceptives and colorectal cancer risk: a meta-analysis.  Br J Cancer . 2001;  84 722-727
    CrossrefPubMedSearch in Google Scholar
  • 46 Martinez M E, Grodstein F, Giovannucci E. A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer.  Cancer Epidemiol Biomark Prev . 1997;  6 1-5
    PubMedSearch in Google Scholar
  • 47 Wingrave S J. Reduction in the incidence of rheumatoid arthritis associated with oral contraceptives: Royal College of General Practitioners' Oral Contraception Study.  Lancet . 1978;  1 569-571
    PubMedSearch in Google Scholar
  • 48 Vandenbroucke J P, Boersma J W, Festen J JM. Oral contraceptives and rheumatoid arthritis: further evidence for a preventive effect.  Lancet . 1982;  2 839-842
    PubMedSearch in Google Scholar
  • 49 Pladevall-Vila M, Delclos G L, Varas C. Controversy of oral contraceptives and risk of rheumatoid arthritis: meta-analysis of conflicting studies and review of conflicting meta-analyses with special emphasis on analysis of heterogeneity.  Am J Epidemiol . 1996;  144 1-14
    PubMedSearch in Google Scholar
  • 50 Ross R K, Pike M C, Vessey M P. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives.  BMJ . 1986;  293 359-362
    PubMedSearch in Google Scholar
  • 51 Chiaffarino F, Parazzini F, La Vecchia C. Use of oral contraceptives and uterine fibroids: results from a case-control study.  Br J Obstet Gynecol . 1999;  106 857-860
    PubMedSearch in Google Scholar
  • 52 Parazzini F, Negri E, La Vecchia, Fedele L, Rabaiotti M, Luchini L. Oral contraceptive use and risk of uterine fibroids.  Obstet Gynecol . 1992;  79 430-433
    PubMedSearch in Google Scholar
  • 53 ACOG Practice Bulletin Number 18. The Use of Hormonal Contraception in Women with Coexisting Medical Conditions. July 2000
  • 54 Gray R H. Toxic shock syndrome and oral contraception [letter].  Am J Obstet Gynecol . 1987;  156 1038
    PubMedSearch in Google Scholar
  • 55 Schwartz B, Gaventa S, Broome C V. Nonmenstrual toxic shock syndrome associated with barrier contraceptives: report of a case-control study.  Rev Infect Dis . 1989;  11(suppl) S43-S48
    PubMedSearch in Google Scholar
  • 56 Reingold A L, Broome C V, Gaventa S. Risk factors for menstrual toxic shock syndrome: results of a multi-state case-control study.  Rev Infect Dis . 1989;  11(suppl) S35-S41
    PubMedSearch in Google Scholar
  • 57 Privrel T, Daubenfeld O. Clinical experience in Switzerland with the new monophasic oral contraceptive Minulet (75 μg gestodene, 30 μg ethinyl estradiol).  Br J Clin Pract . 1988;  42 292-298
    PubMedSearch in Google Scholar
  • 58 Ulstien M, Svendsen E, Steier A. Clinical experience with a triphasic oral contraceptive.  Acta Obstet Gynecol Scand . 1984;  63 233-236
    PubMedSearch in Google Scholar
  • 59 Klein J R, Litt I F. Epidemiology of adolescent dysmenorrhea.  Pediatrics . 1981;  68 661-664
    CrossrefPubMedSearch in Google Scholar
  • 60 Lavin C. Dysfunctional uterine bleeding in adolescents.  Curr Opin Pediatr . 1996;  8 328-332
    PubMedSearch in Google Scholar
  • 61 Davis A, Godwin A, Lippman J. Triphasic norgestimate-ethinyl estradiol for treating dysfunctional uterine bleeding.  Obstet Gynecol . 2000;  96 913-920
    CrossrefPubMedSearch in Google Scholar
  • 62 Iyer V, Farquhar C, Jepson R. Oral contraceptive pills for heavy menstrual bleeding (Cochrane Review). In: The Cochrane Library Issue 2. Oxford: Update Software; 1999
    Search in Google Scholar
  • 63 Chuong C J, Brenner P F. Management of abnormal uterine bleeding.  Am J Obstet Gynecol . 1996;  175 787-792
    PubMedSearch in Google Scholar
  • 64 Arias R D. Therapeutic uses of oral contraceptives. In: Arias RD, ed. Benefits and Risks of Oral Contraceptives: A Current Perspective Little Falls, NJ: Health Learning System, Inc. 1997: 55-59
    Search in Google Scholar
  • 65 Raj S G, Raj N H, Talbert L M. Normalization of testosterone levels using a low estrogen-containing oral contraceptive in women with polycystic ovarian syndrome.  Obstet Gynecol . 1982;  60 15-19
    PubMedSearch in Google Scholar
  • 66 Palatsi R, Hirvensalo E, Liukko P. Serum total and unbound testosterone and sex hormone binding globulin (SHBG) in female acne patients treated with two different oral contraceptives.  Acta Derm Venereol . 1984;  64 517-523
    PubMedSearch in Google Scholar
  • 67 Weber-Diehl F, Unger R, Lachnit-Fixson U. Triphasic combination of ethinyl estradiol and gestodene.  Contraception . 1992;  46 19-27
    CrossrefPubMedSearch in Google Scholar
  • 68 Azziz R, Gay F. The treatment of hyperandrogenism with oral contraceptives.  Sem Reprod Endocrinol . 1989;  7 246-254
    PubMedSearch in Google Scholar
  • 69 Lemay A, Dewailly S D, Grenier R. Attenuation of mild hyperandrogenic activity in postpubertal acne by a triphasic oral contraceptive containing low doses of ethinyl estradiol and d,1-norgestrel.  J Clin Endocrinol Metab . 1990;  71 8-14
    PubMedSearch in Google Scholar
  • 70 Loudon N B, Kirkman R JE, Dewsbury J A. Double-blind comparison of Femodene and Microgynon.  Eur J Obstet Gynecol Reprod Biol . 1990;  34 257-266
    CrossrefPubMedSearch in Google Scholar
  • 71 Wishart J M. An open study of Triphasil and Diane 50 in the treatment of acne.  Australas J Dermatol . 1991;  32 51-54
    PubMedSearch in Google Scholar
  • 72 Redmond G P, Olson W H, Lippman J S. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: a randomized, placebo-controlled trial.  Obstet Gynecol . 1997;  89 615-622
    CrossrefPubMedSearch in Google Scholar
  • 73 Lucky A W, Henderson T A, Olson W H. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris.  J Am Acad Dermatol . 1997;  37 746-754
    PubMedSearch in Google Scholar
  • 74 Thorneycroft I H, Stanczyk F Z, Bradshaw K D. Effect of low-dose oral contraceptives on androgenic markers and acne.  Contraception . 1999;  60 255-262
    CrossrefPubMedSearch in Google Scholar
  • 75 Burkman Jr T R. The role of oral contraceptives in the treatment of hyperandrogenic disorders.  Am J Med . 1995;  98(suppl) 130S-136S
    CrossrefPubMedSearch in Google Scholar
  • 76 Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review). In: The Cochrane Library Issue 2. Oxford: Update Software; 1999
    Search in Google Scholar
  • 77 Cumming D C. Exercise-associated amenorrhea, low bone density, and estrogen replacement therapy.  Arch Intern Med . 1996;  156 2193-2195
    CrossrefPubMedSearch in Google Scholar
  • 78 Chen E C, Brzyski R G. Exercise and reproductive dysfunction.  Fertil Steril . 1999;  71 1-6
    CrossrefPubMedSearch in Google Scholar
  • 79 Warren M P, Stiehl A L. Exercise and female adolescents: effects on the reproductive and skeletal systems.  J Am Med Womens Assoc . 1999;  54 115-138
    PubMedSearch in Google Scholar
  • 80 Hergenroeder A C. Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults.  J Pediatr . 1995;  126 683-689
    PubMedSearch in Google Scholar
  • 81 Spanos W J. Preoperative hormonal therapy of cystic adnexal masses.  Am J Obstet Gynecol . 1973;  116 551-556
    PubMedSearch in Google Scholar
  • 82 Steinkampf M P, Hammond K R, Blackwell R E. Hormonal treatment of functional ovarian cysts: a randomized, prospective study.  Fertil Steril . 1990;  54 775-777
    PubMedSearch in Google Scholar
  • 83 Daugherty J E. Treatment strategies for premenstrual syndrome.  Am Fam Physician . 1998;  58 183-192
    PubMedSearch in Google Scholar
  • 84 Barnhart K T, Freeman E, Sondheimer S. Premenstrual syndrome: a clinician's view.  Med Clin North Am . 1995;  79 1457-1472
    PubMedSearch in Google Scholar
  • 85 Sulak P J, Cressman B E, Waldrop E, Holleman S, Kuehl T J. Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms.  Obstet Gynecol . 1997;  89 179-183
    CrossrefPubMedSearch in Google Scholar
  • 86 Silberstein S D, Merriam G R. Sex hormones and headache.  J Pain Symptom Manage . 1993;  8 98-114
    CrossrefPubMedSearch in Google Scholar