Noncontraceptive Benefits and Therapeutic Uses of the Oral Contraceptive Pill

Molina Dayal; Kurt T. Barnhart

doi:10.1055/s-2001-18637

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med 2001; 19(4): 295-304
DOI: 10.1055/s-2001-18637

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

Abstract

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

Full Text

References

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
4 Schlesselman J J. Cancer of the breast and reproductive tract in relation to use of oral contraceptives. Contraception . 1989; 40 1-38
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
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
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
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
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
10 Prentice R L, Thomas D B. On the epidemiology of oral contraceptives and disease. Adv Cancer Res . 1987; 49 285-401
11 Schlesselman J J. Oral contraceptives and neoplasia of the uterine corpus. Contraception . 1991; 43 557-579
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
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
14 Mishell Jr R D. Noncontraceptive benefits of oral contraceptives. J Reprod Med . 1993; 38 1021-1029
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
16 Ory H W. The noncontraceptive health benefits from oral contraceptive use. Fam Plan Perspect . 1982; 14 182-184
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
18 Brinton L A, Vessey M P, Flavel R. Risk factors for benign breast disease. Am J Epidemiol . 1981; 113 203-214
19 Mishell Jr R D. Noncontraceptive health benefits of oral steroidal contraceptives. Am J Obstet Gynecol . 1982; 142 809-816
20 Rubin G L, Ory H W, Layde P M. Oral contraceptives and pelvic inflammatory disease. Am J Obstet Gynecol . 1982; 144 630-635
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
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
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
24 Wolner-Hannsen P. Oral contraceptive use modifies the manifestations of pelvic inflammatory disease. Br J Obstet Gynaecol . 1986; 93 619-624
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
26 Svensson L, Westrom L, Mardh P. Contraceptives and acute salpingitis. JAMA . 1984; 251 2553-2555
27 Franks A L, Beral V, Cates Jr W. Contraception and ectopic pregnancy risk. Am J Obstet Gynecol . 1990; 163 1120-1123
28 Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol . 1991; 78 291-298
29 Sivin I. International experience with NORPLANT and NORPLANT-2 contraceptives. Stud Fam Plann . 1988; 19 81-94
30 Vessey M, Metcalfe A, Wells C. Ovarian neoplasms, functional ovarian cysts, and oral contraceptives. BMJ . 1987; 294 1518-1520
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
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
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
34 Cooper C, Hannaford P, Croft P. Oral contraceptive pill use and fractures in women: a prospective study. Bone . 1993; 14 41-45
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
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
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
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
39 DeCherney A. Bone-sparing properties of oral contraceptives. Am J Obstet Gynecol . 1996; 174 15-20
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
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
42 Kune G A, Kune S, Watson L F. Oral contraceptive use does not protect against large bowel cancer. Contraception . 1990; 41 19-25
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
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
45 Fernandez E, La Vecchia C, Balducci A. Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer . 2001; 84 722-727
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
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
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
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
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
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
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
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
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
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
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
58 Ulstien M, Svendsen E, Steier A. Clinical experience with a triphasic oral contraceptive. Acta Obstet Gynecol Scand . 1984; 63 233-236
59 Klein J R, Litt I F. Epidemiology of adolescent dysmenorrhea. Pediatrics . 1981; 68 661-664
60 Lavin C. Dysfunctional uterine bleeding in adolescents. Curr Opin Pediatr . 1996; 8 328-332
61 Davis A, Godwin A, Lippman J. Triphasic norgestimate-ethinyl estradiol for treating dysfunctional uterine bleeding. Obstet Gynecol . 2000; 96 913-920
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
63 Chuong C J, Brenner P F. Management of abnormal uterine bleeding. Am J Obstet Gynecol . 1996; 175 787-792
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
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
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
67 Weber-Diehl F, Unger R, Lachnit-Fixson U. Triphasic combination of ethinyl estradiol and gestodene. Contraception . 1992; 46 19-27
68 Azziz R, Gay F. The treatment of hyperandrogenism with oral contraceptives. Sem Reprod Endocrinol . 1989; 7 246-254
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
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
71 Wishart J M. An open study of Triphasil and Diane 50 in the treatment of acne. Australas J Dermatol . 1991; 32 51-54
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
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
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
75 Burkman Jr T R. The role of oral contraceptives in the treatment of hyperandrogenic disorders. Am J Med . 1995; 98(suppl) 130S-136S
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
77 Cumming D C. Exercise-associated amenorrhea, low bone density, and estrogen replacement therapy. Arch Intern Med . 1996; 156 2193-2195
78 Chen E C, Brzyski R G. Exercise and reproductive dysfunction. Fertil Steril . 1999; 71 1-6
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
80 Hergenroeder A C. Bone mineralization, hypothalamic amenorrhea, and sex steroid therapy in female adolescents and young adults. J Pediatr . 1995; 126 683-689
81 Spanos W J. Preoperative hormonal therapy of cystic adnexal masses. Am J Obstet Gynecol . 1973; 116 551-556
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
83 Daugherty J E. Treatment strategies for premenstrual syndrome. Am Fam Physician . 1998; 58 183-192
84 Barnhart K T, Freeman E, Sondheimer S. Premenstrual syndrome: a clinician's view. Med Clin North Am . 1995; 79 1457-1472
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
86 Silberstein S D, Merriam G R. Sex hormones and headache. J Pain Symptom Manage . 1993; 8 98-114