Health Talk

All you wanted to know about oral contraceptives



Although oral contraceptives have been in use for more than 30 years, and despite innumerable analysis of their effects, expert continue to disagree about their safety and adverse effects. These drugs nearly always contain a synthetic estradiol and variable amounts of a progestin (combined contraceptives), but a few preparations contain only progestins. Currently prescribed oral contraceptives contain smaller amounts of estrogens (<50 micro gram per day) and are clearly associated with fewer side effects than their earlier formulation.

Apart from the family planning benefits of oral contraceptive use (bringing down population growth by avoiding unwanted births so as to ensure better standard of living, improve health of the mother and their children by bringing wanted birth so that a healthier society emerges, regulate interval between pregnancies, reduces maternal and infant mortality rate, reduces number of unwanted pregnancy and the number of illegal abortions); the other beneficial effects are relief of dysmenorrhoea, premenstrual tension, endometriosis, acne, hirsutism; protection against benign breast disorder including fibrocystic disease and fibroadenoma, ovarian cyst, iron deficiency anemia and lesser chance of ectopic pregnancy and pelvic inflammatory disease. 

The minor unwanted effects of oral contraceptive use are nausea, vomiting, headache, migraine, depression, change of mood disorder, sleep disturbance, break through bleeding, diminished libido, leucorrhoea, breast tenderness, breast fullness, leg cramp, weight gain and hypomenorrhoea or amenorrhoea.

Oral contraceptives carry some increased risk of cervical cancer, which is co-related with duration of use. More recent studies suggest that the increased risk may be more strongly co-related with life style than with the drug.

The oral contraceptives used in the past (>50 micro gram estrogen) were clearly associated with an increased risk of venous thrombosis and pulmonary thromboembolism because of increased hepatic synthesis of coagulation factors and reduced levels of antithrombin III. Data with the newer (second-generation) formulations (<50 micro gram estrogens) suggest that the overall risk is much less, especially in women younger than 35 years who don't smoke and don't have other predisposing influences such as diabetes. 

More recently, third-generation oral contraceptives, which combine low dose estrogens with synthetic progestins, affect LDL and HDL levels to a lesser extent than natural progestins do and hence the risk of acute myocardial infarction is reduced. 

Recent evidence states that non-smoking, healthy women younger than 45 years who use the newer low-estrogen formulation do not incur an increased risk of ischemic heart disease. Conversely, young women smokers who use the pills are ten times more likely to suffer myocardial infarction than users who do not smoke. 

There is a well-defined association between the use of oral contraceptives and the rare benign tumor hepatic adenoma, especially in older women who have used oral contraceptives for prolonged periods.

Obviously, the pros and cons of oral contraceptives use must be viewed in the context of their wide applicability and acceptance as a form of contraception that protects against unwanted pregnancies with their attendant hazards.