Long-term Use of Combined Oral Contraceptives:Myths versus Reality

Overview

Objective:
To assess relationship of long-term use of combined oral contraception (COC) andwomen health, discussion about myths connected with use of COC.Design: Review of literature.Setting: Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, CzechRepublic.Methods: Identification of studies able to address the topic using Medline database search.Results: Besides reliable control of fertility COC protect women against dysmenorrhea, iron deficiencyanemia, ovarian cysts and uterine fibroids.COC plays very important role in gynecologic endocrinology supressing effectively hyperandrogenism,which has not only cosmetic effect but brings also improvement in cardiovascular health ofaffected perimenopausal women.Premenopausal using of COC could help preserve bone mineral density and can reduce the risk ofdeveloping Alzheimer’s disease. The most importmant feature is protective effect against endometrial(by 70%) and ovarian (by 50%) cancer which increases with duration of COC use and islong lasting and may be observed 15 to 20 years after stopping use.Association of use COC with increased risk neither of cervical cancer nor breast cancer has notbeen confirmed. Controversy still persists over the association of long-term (longer than 8 years)COC use by young nulliparas and breast cancer. The risk in this group of users is probablyslightly increased. But no authorities recommended any restriction of COC’s prescription. Somestudies have suggested an inverse relationship between use of COC and risk of colorectal cancer.The only established evidence of direct association between OC use and cancer risk is the increasedrisk for hepatocellular carcinoma in the absence of hepatitis B (but maximum by 4 cases per 1000 000 users per year).Conclusion: Most non-contraceptive health benefits of COC are still not widely appreciated inspite of much evidence. The final decision of contraception method is upon well and adequateinformed user by well educated doctor.

Key words:
control of fertility, dysmenorhea, ovarian cysts, hyperandrogenism, perimenopausalwomen, uterine fibroids