Long-term Use of Combined Oral Contraceptives:
Myths versus Reality
Novotná M.1 Huvar I.1, Bláha O.2
1Gynekologicko-porodnické oddělení Nemocnice Milosrdných bratří, Brno, přednosta prim.MUDr. I.Huvar, CSc. 2Unica – klinika pro léčbu neplodnosti a ženských nemocí, Brno, přednosta prof. MUDr. Z. Malý, CSc. |
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Summary:
Objective: To assess relationship of long-term use of combined oral contraception (COC) and
women health, discussion about myths connected with use of COC.
Design: Review of literature.
Setting: Department of Obstetrics and Gynaecology, Hospital of Merciful Brothers, Brno, Czech
Republic.
Methods: Identification of studies able to address the topic using Medline database search.
Results: Besides reliable control of fertility COC protect women against dysmenorrhea, iron deficiency
anemia, ovarian cysts and uterine fibroids.
COC plays very important role in gynecologic endocrinology supressing effectively hyperandrogenism,
which has not only cosmetic effect but brings also improvement in cardiovascular health of
affected perimenopausal women.
Premenopausal using of COC could help preserve bone mineral density and can reduce the risk of
developing Alzheimer’s disease. The most importmant feature is protective effect against endometrial
(by 70%) and ovarian (by 50%) cancer which increases with duration of COC use and is
long lasting and may be observed 15 to 20 years after stopping use.
Association of use COC with increased risk neither of cervical cancer nor breast cancer has not
been confirmed. Controversy still persists over the association of long-term (longer than 8 years)
COC use by young nulliparas and breast cancer. The risk in this group of users is probably
slightly increased. But no authorities recommended any restriction of COC’s prescription. Some
studies have suggested an inverse relationship between use of COC and risk of colorectal cancer.
The only established evidence of direct association between OC use and cancer risk is the increased
risk for hepatocellular carcinoma in the absence of hepatitis B (but maximum by 4 cases per 1
000 000 users per year).
Conclusion: Most non-contraceptive health benefits of COC are still not widely appreciated in
spite of much evidence. The final decision of contraception method is upon well and adequate
informed user by well educated doctor.
Key words:
control of fertility, dysmenorhea, ovarian cysts, hyperandrogenism, perimenopausal
women, uterine fibroids
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