The combined oral contraceptive pill in women over age forty.
BACKGROUND
By the age of 35 years, most women would have completed their families and contraception then becomes an important consideration. In the next one or two decades, other health concerns such as osteoporosis, dysfunctional uterine bleeding, ovarian, endometrial, colorectal and breast cancers and cardiovascular diseases will assume prominence in the lives of women. We review the role of the combined oral contraceptive (OC) pill in the older woman in the context of these important health concerns.


METHODS
A Medline search was made for possible interaction between OC use and the above conditions. An important criteria for citation was publication in a high impact factor journal; furthermore to represent the wider context from which there issues derive we choose, whenever appropriate, general journal with wide readership including, but not limited to the Lancet or New England Journal of Medicine; we also choose studies published in journals of other medical disciplines instead of purely gynaecological journals to reflect the multidisciplinary impact of the combined OC pills.


RESULTS
Combined OC retards bone demineralisation which could translate clinically to a reduction in postmenopausal osteoporotic fractures; it affords good menstrual cyclicity and alleviation of perimenopausal vasomotor symptoms; it offers chemoporophylaxis against epithelial ovarian cancers and endometrial cancers. There is evidence that it could be protective against colorectal cancers. The combined OC may attenuate the disease progression of rheumatoid arthritis and reduces the risk of ectopic pregnancy and pelvic inflammatory disease. In an older woman who does not smoke and is in good health, the excess risk of stroke, myocardial infarcts and venous thromboembolism is minimal, if at all, as is the risk of breast neoplasm. In women with proven human papilomavirus infection of the cervix who are using OCs, regular cervical screening is especially important.


CONCLUSIONS
The non-contraceptive health benefits of the combined OCs justify its usage in the healthy older woman.
Wong
M T
MT
Department of Obstetrics and Gynaecology, National University Hospital, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074.
Singh
K
K
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D003657:Decision Making; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012846:Singapore / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000209:etiology*
D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal