Discussing oral contraceptive risks and benefits

Combined oral contraceptives (COCs) are among the medications I prescribe most frequently. In my patient population “the pill” is the most popular contraceptive method. There are many noncontraceptive benefits to hormonal birth control, too, and I often prescribe COCs to treat a variety of gynecologic and generalized problems. 

Because there is such a wide variety of COCs available, if a particular formulation or dose causes unwanted side effects it is easy to switch pills until you find the one that is right for your patient. Reviewing the risks and benefits can aid in this process.

Menstrual cycle disorders such as irregular periods and menorrhagia, often among women who are not sexually active, are common complaints. COCs offer a safe and effective treatment for these conditions after possible underlying causes, such a pregnancy, thyroid disease or infection, have been ruled out. COCs are also a useful treatment option for patients with anovulatory bleeding due to polycystic ovarian syndrome. 

Dysmenorrhea is common among all women, but particularly prevalent in adolescents. COCs can decrease the level of prostaglandins, the primary hormone responsible for painful periods. COCs are also an effective option for pain caused by endometriosis, particularly when used on a continuous basis to eliminate menstruation completely. 

Certain types of COCs can be effective for treating moderate-to-severe acne, premenstrual syndrome and premenstrual dysphoric disorder.  

In my older patient population, perimenopausal women enjoy the cycle control of COCs, but many do not know that COCs also increase bone mineral density and decrease the risk for certain cancers including ovarian, endometrial and colorectal cancers. 

"The pill" is not for everyone, though. Women who smoke and are older than 35 years should not be on COCs.  Women who suffer from migraine headaches with aura, high BP or blood clotting disorders are usually not candidates for COCs. It is important to discuss these risks, as well as warning signs, with every woman who begins taking a COC. 

Even for women who are using COCs primarily as a contraceptive method, reviewing the myriad noncontraceptive benefits is an important part of patient education. 

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