title: Hormonal contraception--what kind, when, and for whom?
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  As long as personal and familial risk factors are carefully considered, COCs constitute a safe, reversible, and well-tolerated method of contraception.
authors.affiliation: 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
authors.forename: Inka
authors.initials: I
authors.lastname: Wiegratz
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Thaler
mesh_terms: D002318:Cardiovascular Diseases / Q000139:chemically induced; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D004343:Drug Implants; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005858:Germany; D006801:Humans; D007273:Injections, Intramuscular; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel; D030361:Papillomavirus Infections / Q000150:complications; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D045167:Progesterone Congeners / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D004343:Drug Implants; D045167:Progesterone Congeners; D016912:Levonorgestrel