Oral contraceptives: an update on health benefits and risks.
OBJECTIVE
To review the health benefits and risks of oral contraceptives, with an emphasis on emerging noncontraceptive benefits and the pharmacist's role in promoting safe and effective use of these widely prescribed medications.


METHODS
Published articles identified through MEDLINE (1995-2001) using the search terms oral contraception, neoplasms, cardiovascular disease, menstrual cycle, and other pertinent subject headings. Additional articles and books were identified from the bibliographies of the retrieved articles.


RESULTS
Combined oral contraceptives (COCs), which contain synthetic estrogen and progestin, are the second most common form of birth control for women after sterilization. When taken properly, COCs are highly effective, with a pregnancy rate of 0.1% among perfect users. Also, a growing body of evidence points to multiple noncontraceptive benefits of COCs, including protection from several types of cancer and a variety of gynecologic benefits, such as reduced menstrual bleeding irregularities and fewer ectopic pregnancies. COCs are one of the most studied classes of medications, and they have been found to have an excellent safety profile in nonsmoking healthy women. They may be used continuously until menopause. For women with coexisting medical conditions or other special circumstances, the risks and benefits of COCs must be carefully evaluated before use.


CONCLUSIONS
More than 40 years after their introduction, COCs remain the leading form of hormonal contraception. By assessing patients' contraceptive needs, evaluating their risk factors, and providing sensitive and thorough counseling, pharmacists can help ensure the safe and effective use of these medications.
Borgelt-Hansen
L
L
University of Colorado Health Sciences Center, School of Pharmacy, Denver 80262, USA. laura.borgelt@uchsc.edu
D000328:Adult; D003157:Community Pharmacy Services / Q000706:statistics & numerical data*; D003276:Contraceptives, Oral / Q000009:adverse effects / Q000627:therapeutic use; D000075202:Contraindications; D003376:Counseling; D005260:Female; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects*; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000139:chemically induced
D003276:Contraceptives, Oral