Noncontraceptive Health Benefits Research Articles

Intrauterine Contraception Benefits Extend Beyond Birth Control

Women of reproductive age (ages 18 to 44) have never known a time when they did not have access to nearly 100% effective contraception. Efficacy is no longer the sole determinant of a contraceptive method. Todays woman wants a method that fits into her lifestyle and offers her other benefits such as improvement in menstrual symptoms decrease in acne and even cancer protection. In addition helping women appreciate these other benefits of contraceptives may improve compliance and continuation reducing the alarming unintended pregnancy rate in the United States. Intrauterine devices have proven to be an exceptional contraceptive method but few healthcare providers and even fewer women are aware of the significant noncontraceptive health benefits these devices offer.

Safety concerns and health benefits associated with oral contraception

Since the introduction of hormonal contraceptives in the 1960s, there have been a variety of both health benefits and safety concerns attributed to their use. In most instances, the noncontraceptive benefits of oral contraceptives (OCs) outweigh the potential cardiovascular risks. In fact, the probability of a patient experiencing a cardiovascular event while taking a low-dose OC is very low. However, smoking, hypertension, obesity, and diabetes are risk factors that must be taken into account when prescribing OCs. The neoplastic effects of hormonal contraceptives have been extensively studied, and recent meta-analyses indicate that there is a reduction in the risk of endometrial and ovarian cancer, a possible small increase in the risk for breast and cervical cancer, and an increased risk of liver cancer. Finally, many women will experience noncontraceptive health benefits with OCs that expand far beyond pregnancy prevention. Some of these benefits include reduction in menstrual-related symptoms, fewer ectopic pregnancies, a possible increase in bone density, and possible protection against pelvic inflammatory disease.

The Combined Oral Contraceptive Pill in Women Over Age Forty

Introduction: 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 chemoprophylaxis 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. Conclusion: The non-contraceptive health benefits of the combined OCs justify its usage in the healthy older woman.

The efficacy of non-contraceptive uses for hormonal contraceptives.

In addition to providing safe and effective contraception, both the combined oral contraceptive pill (COCP) and selected long-acting progestogen-only contraceptives have significant health benefits. The COCP may reduce menstrual blood loss, dysmenorrhoea and premenstrual syndrome; unequivocally reduces the later incidence of endometrial and ovarian cancer; appears to help protect future fertility, probably by reducing the risk of acute pelvic inflammatory disease, endometriosis and uterine fibroids. The quality of evidence for individual non-contraceptive health benefits of the COCP is very variable.

Oral contraception

An orally administered formulation intended to prevent pregnancy. Oral contraception in women is available in two formulations: products containing both oestrogen and progestogen – combined oral contraceptives (COCs, The Pill) and those containing progestogen alone – progestogen-only pills (POPs, The Mini-Pill). COCs first became available in the UK in 1961 and have become an extremely safe, effective and popular method of reversible contraception. They also benefit from having non-contraceptive health benefits. This article aims to outline the advantages and disadvantages of taking oral contraception and important aspects of safe prescribing. Initially the article will focus on the COC pill, with the differences arising with the progestogen-only pill outlined later.

New Contraceptive Methods

To provide an update on the current trend toward increasing use of emergency postcoital contraception, continuous (or "extended-use") oral contraceptives (OCs) and longer-acting contraceptive delivery systems.This review is based largely upon patient care-oriented clinical experience data, including some original work submitted to the U.S. Food and Drug Administration by the primary investigators of these novel methods, supplemented, when appropriate, with basic pharmacologic and pharmacokinetic information.This review is a distillation based on an exhaustive literature search of each of the following topics: emergency postcoital contraception, continuous (extended-use) oral contraception, the weekly patch, the monthly vaginal ring and the monthly injectable. The issue of OC formulations recently begun to be marketed in this country was excluded since they have been extensively reviewed elsewhere.Emergency postcoital contraception is highly effective, though not as effective as available proactive methods of hormonal contraception. Of the popular regimens available, all have similar efficacy; those without estrogen are associated with less nausea and vomiting. The prophylactic administration of an antiemetic 1 hour prior to the first contraceptive dose can mitigate this adverse side effect. Continuous (or "extended" use) of OCs has become increasingly popular. This can decrease or eliminate menstruation as well as several menstruation-related complaints (e.g., dysmenorrhea, menstrual migraines and premenstrual symptoms). Despite the fact that combination OC regimens offer highly reliable contraception as well as several noncontraceptive health benefits, they are limited by the issue of daily compliance. To address this limitation, several longer-acting delivery systems were recently developed. The weekly patch, monthly vaginal ring and monthly injectable have efficacy and side effect profiles similar to those of comparable OC formulations. They offer the advantages of longer action and lower and more steady steroid levels and are free of the challenges associated with daily compliance.We need to continue to develop new and highly effective means of contraception that offer women ease of use and minimal side effects, hence leading to successful and effective use.

Continuation and compliance of contraceptive use

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera®. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

The Checkered History and Bright Future of Intrauterine Contraception in the United States

The IUD was once a popular form of birth control in the US. It is noted that the sharp drop in IUD use resulted from a combination of interrelated factors and events. However since the IUD is almost impossible to misuse and is far less likely to fail than the pill the condom or the injectable a national increase in IUD use that comes at the expense of such methods would reduce the number of unintended pregnancies. This paper outlines factors that comprise the history and future of IUD in the US. Factors such as new research documenting safety a clear public health need many advantages over other reversible contraceptive methods newly discovered noncontraceptive health benefits a choice of two excellent devices and favorable assessments (by contraceptive experts women physicians satisfied current users and women in other countries) predict a renewed interest in IUD among women users in the US. Together these positive forces may well overcome barriers to IUD provision rid the device of its tainted image and lead to expanded reproductive health choice.

Noncontraceptive health benefits of intrauterine devices: a systematic review.

Most women and their clinicians are unaware that IUDs confer important noncontraceptive health benefits. This review summarizes the evidence from published articles on this topic. We conducted a series of systematic literature searches to identify articles on the noncontraceptive health benefits of IUD use. We reviewed the potentially pertinent ones for content, grouped them according to type of IUD, and evaluated them using the U.S. Preventive Services Task Force rating system. Over 500 titles were identified and several hundred abstracts were reviewed. Use of nonhormonal IUDs (plastic and copper) was associated with a decrease in endometrial cancer. The levonorgestrel intrauterine system can treat a variety of gynecological disorders, including menorrhagia and anemia. The levonorgestrel system has also been used successfully as part of hormone replacement therapy, as adjuvant therapy with tamoxifen, and as an alternative to hysterectomy for women with bleeding problems. Like oral contraceptives, intrauterine contraceptives confer important noncontraceptive health benefits.

Noncontraceptive health benefits of oral contraceptives.

Noncontraceptive health benefits of oral contraceptives.

Continuation and compliance of contraceptive use

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented.The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants,intrauterine devices (IUD), the pill and Depo-Provera®. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation ratesare highest for methods not affected by compliance.Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptiveuse (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectivenesscan largely be attributed to compliance with the prescribed contraceptive regimens.Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition,the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

Combined oral hormone replacement therapy formulations

Today, clinicians are challenged to address a woman's contraceptive needs during her reproductive and perimenopausal years and then provide her with a menopausal therapeutic option. This option should offer optimal symptom relief, noncontraceptive health benefits, and a good tolerability profile. The benefits of hormone replacement therapy include control of vasomotor symptoms, reduction of vulvovaginal atrophy, and protection against osteoporosis. Research also points to emerging hormone replacement therapy benefits such as protection against cardiovascular disease, colon cancer, and Alzheimer's disease. One of the primary considerations in the transition from oral contraceptive use to hormone replacement therapy is the tolerability profile of the progestin component of the hormone replacement therapy. Because progestin-related side effects are among the main reasons for discontinuation of hormone replacement therapy, the selection of a formulation that contains the same well-tolerated progestin as in the woman's oral contraceptive can be particularly important to successful use of hormone replacement therapy. Currently in the United States continuous combined hormone replacement therapy is available in 3 formulations and 1 continuous estrogen/intermittent progestin formulation. Although direct comparative trials are lacking, available data suggest that the new, continuous 17β-estradiol/intermittent norgestimate hormone replacement therapy formulation may offer advantages over regimens that contain older progestins with metabolic disadvantages. (Am J Obstet Gynecol 2001;185:S38-46.)

Current perspectives on oral contraceptive use

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life. (Am J Obstet Gynecol 2001;185:S4-12.)

Introduction

Hormonal formulations prevent unintended pregnancies, provide noncontraceptive health benefits, ease perimenopausal and menopausal symptoms, and substantially reduce both short- and long-term health risks for women. Yet, in spite of the fact that oral contraceptives (OCs) are the most popular reversible contraceptive method among younger women, most perimenopausal and menopausal women choose to not use or to prematurely discontinue these therapies. The challenge for clinicians who treat women in these age groups is multifaceted: to assist women in understanding how health needs alter with age; to increase awareness of current and future health risks associated with age-related changes in endogenous hormone levels; and to help women assess the value of therapeutic options addressing these concerns.

The promise and performance of progestogens as contraceptives.

Progestogens were first suggested as possible contraceptives in the 1920s, but it was not until the early 1960s that effective progestogen-only contraceptive methods were developed. Since then it has become possible to deliver a range of different progestogens at varying doses, by a variety of routes, over greatly differing durations of time. Some of these systems have demonstrated extraordinarily high contraceptive efficacy with relatively few side-effects apart from unpredictable, but almost universal, disturbances of the menstrual pattern. It is now recognized that some systems may exhibit substantial non-contraceptive health benefits, which should become an important part of the overall performance profile of each method. The high technology and differing attributes associated with some of the systems raise important considerations in relation to user's perceptions and programmatic requirements. Overall, progestogens are able to offer women a varied range of valuable choices for contraception. The differing performance characteristics of these methods now provide women with a major portion of their current contraceptive choices.

Forty years of combined oral contraception: the evolution of a revolution

The combined oral contraceptive (COC) pill has become an integral part of fertility choice in almost every country since its introduction in 1960 in the United States. It was the first contraceptive method to provide sexual freedom of choice for women through reliable personal, private control of fertility. Modern, very low-dose pills have maintained a high degree of contraceptive efficacy, but the margin for error in pill-taking appears much smaller. These COCs have a much lower incidence of side effects and serious complications than early high-dose COCs. Serious health risks from venous thromboembolism are rare, and not measurably higher for pills containing third-generation compared with earlier progestogens. Most women feel very well taking modern COCs, but myths about these drugs still abound. Most non-contraceptive health benefits of COCs are still not widely appreciated in spite of much evidence. Controversy still persists over the association between COC use and breast cancer. Although slightly more breast cancers are detected in current COC users (relative risk 1.24; 95% CI, 1.15-1.33), they are less advanced and less aggressive. Some women have pre-existing medical risk factors for COC use, and a detailed history for cardiovascular risk factors is one of the most important precautions.

Oral contraceptive health benefits: perception versus reality

Many women remain unaware of classic oral contraceptive (OC) noncontraceptive health benefits even as new health advantages emerge from experience and research. An extensive body of evidence has established that OC protect women against dysmenorrhea and menorrhagia, menstrual cycle irregularities, iron deficiency anemia, ectopic pregnancy, pelvic inflammatory disease, ovarian cysts, benign breast disease, endometrial cancer, and ovarian cancer. In addition, the FDA has stated for the first time that an OC—triphasic norgestimate/35 μg ethinyl estradiol—is an effective treatment for moderate acne vulgaris. OC use also appears to prevent osteopenia in hypoestrogenic women. In addition to these noncontraceptive health benefits, OC have proven valuable in the management of a variety of gynecologic disorders, including dysfunctional uterine bleeding, persistent anovulation, premature ovarian failure, functional ovarian cysts, pelvic pain (including secondary dysmenorrhea), mittelschmerz, endometriosis, and the control of bleeding in women with blood dyscrasias. Educating healthcare providers and women about these important noncontraceptive health benefits will result in increased compliance, greater continuation, and fewer unintended pregnancies.

Foreword

Since its introduction in the United States in 1960, the oral contraceptive (OC) pill has empowered women to make individual choices about when or whether to have children and pursue marriage/relationships, education, careers, and professional development. By providing safe, effective fertility control, OC have decreased the rate of unintended pregnancies. Moreover, a large amount of data indicates that OC use is associated with many short- and long-term noncontraceptive health benefits that increase in magnitude with long-term use. Nevertheless, many women remain anxious and ambivalent about OC use, and some healthcare providers may perpetuate unfounded misperceptions regarding the pill. Healthcare providers need to be well informed about all the effects produced by OC so they can better educate their patients about these agents.

Oral contraception: current use and attitudes

Oral contraception (OC) has been available for almost four decades. During this time, changes in contraceptive use in general and OC in particular have occurred. Knowledge and attitudes about OC may not always reflect trends in use. Contraceptive use data from 1965–1995 show that OC continue to be the method chosen consistently by more than one-quarter of women contraceptors. Probably even more women would use the pill if they had more accurate information regarding the higher failure rates with barrier methods (especially the condom), if misperceptions about OC safety were put to rest, and if greater awareness of the noncontraceptive health benefits of OC could be achieved. Increased education and awareness of women as well as their healthcare providers has the potential to positively affect future contraceptive use.

Introduction of the pill and its impact

Introduction of the birth control pill in the United States in 1960 marked the end of a relatively short period of time (<10 years) to intentionally produce an oral contraceptive, and the beginning of a relatively long period of controversy surrounding the use of the pill. Availability of the pill had an impact on various aspects of social life, including women’s health, fertility trends, laws and policies, religion, interpersonal relationships and family roles, feminist issues, and gender relations, as well as sexual practices among both adults and adolescents. The pill proved to be highly effective from the outset. Although safety issues developed with the earlier formulations, continued evolution of pill hormones and doses has resulted in a greatly improved and safe oral contraceptive. A broad range of noncontraceptive health benefits also is associated with the pill. These health effects are significant, as they include protection against potentially fatal diseases, including ovarian and endometrial cancers, as well as against other conditions that are associated with substantial morbidity and potential hospitalization and associated costs. The popularity of the pill has remained high, with rates of use in the past 30 years in the United States ranging from one-quarter to almost one-third of women using contraception. Almost 40 years after its introduction, the pill’s contraceptive efficacy is proven, its improved safety has been established, and the focus has shifted from supposed health risks to documented and real health benefits.