Inka Wiegratz1, Christian J Thaler. 1. Klinik für Frauenheilkunde und Geburtshilfe, Schwerpunkt Gynäkologische Endokrinologie und Reproduktionsmedizin, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Germany. Inka.Wiegratz@kgu.de
Abstract
BACKGROUND: In Germany today, one-third of the 20 million women of child-bearing age use combined oral contraceptives (COCs). In this article, we summarize the current knowledge of the mode of action, wanted and unwanted side effects, and long-term risks of COCs. The levonorgestrel intrauterine device (IUD) and long-acting injectable or implantable monophasic progestogen preparations offer comparable contraceptive efficacy to COCs. Nonetheless, they are less frequently used in Germany than COCs, because of their propensity to cause breakthrough bleeding. METHOD: Selective review of the literature. RESULTS: COCs suppress gonadotropin secretion and thereby inhibit follicular maturation and ovulation. Their correct use is associated with 0.3 pregnancies per 100 women per year, their typical use, with 1 pregnancy per 100 women per year (Pearl index). COCs have effects on the cardiovascular and hemostatic systems as well as on lipid and carbohydrate metabolism. When given in the presence of specific risk factors, they significantly increase the likelihood of cardiovascular disease and thromboembolism. Women with persistent human papilloma virus (HPV) infection who take COCs are at increased risk of developing invasive cervical cancer. On the other hand, COCs lower the cumulative incidence of endometrial and ovarian cancer by 30% to 50%, and that of colorectal cancer by 20% to 30%. Other malignancies seem to be unaffected by COC use. CONCLUSION: As long as personal and familial risk factors are carefully considered, COCs constitute a safe, reversible, and well-tolerated method of contraception.
BACKGROUND: In Germany today, one-third of the 20 million women of child-bearing age use combined oral contraceptives (COCs). In this article, we summarize the current knowledge of the mode of action, wanted and unwanted side effects, and long-term risks of COCs. The levonorgestrel intrauterine device (IUD) and long-acting injectable or implantable monophasic progestogen preparations offer comparable contraceptive efficacy to COCs. Nonetheless, they are less frequently used in Germany than COCs, because of their propensity to cause breakthrough bleeding. METHOD: Selective review of the literature. RESULTS: COCs suppress gonadotropin secretion and thereby inhibit follicular maturation and ovulation. Their correct use is associated with 0.3 pregnancies per 100 women per year, their typical use, with 1 pregnancy per 100 women per year (Pearl index). COCs have effects on the cardiovascular and hemostatic systems as well as on lipid and carbohydrate metabolism. When given in the presence of specific risk factors, they significantly increase the likelihood of cardiovascular disease and thromboembolism. Women with persistent human papilloma virus (HPV) infection who take COCs are at increased risk of developing invasive cervical cancer. On the other hand, COCs lower the cumulative incidence of endometrial and ovarian cancer by 30% to 50%, and that of colorectal cancer by 20% to 30%. Other malignancies seem to be unaffected by COC use. CONCLUSION: As long as personal and familial risk factors are carefully considered, COCs constitute a safe, reversible, and well-tolerated method of contraception.
Authors: Polly A Marchbanks; Jill A McDonald; Hoyt G Wilson; Suzanne G Folger; Michele G Mandel; Janet R Daling; Leslie Bernstein; Kathleen E Malone; Giske Ursin; Brian L Strom; Sandra A Norman; Phyllis A Wingo; Ronald T Burkman; Jesse A Berlin; Michael S Simon; Robert Spirtas; Linda K Weiss Journal: N Engl J Med Date: 2002-06-27 Impact factor: 91.245
Authors: Victor Moreno; F Xavier Bosch; Nubia Muñoz; Chris J L M Meijer; Keerti V Shah; Jan M M Walboomers; Rolando Herrero; Silvia Franceschi Journal: Lancet Date: 2002-03-30 Impact factor: 79.321
Authors: Simone Reinmuth; Cynthia Hohmann; Rosa Rendtorff; Magdalena Balcerek; Steve Holzhausen; Andreas Müller; Günter Henze; Thomas Keil; Anja Borgmann-Staudt Journal: J Cancer Res Clin Oncol Date: 2013-10-02 Impact factor: 4.553
Authors: Kerstin Weitmann; Carsten Hirt; Sabine Schwarz; Charles Rabkin; Gottfried Dölken; Wolfgang Hoffmann Journal: Cancer Causes Control Date: 2015-01-30 Impact factor: 2.506