POPULATION REPORTS
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Photo of an Egyptian woman taking a pill.
Egypt Ministry of Health

CONTENTS

          Chapters
  1. Background
  2. Oral Contraceptive Use
  3. Benefits of Oral Contraceptives
  4. Health Risks of Oral Contraceptives
  5. Unresolved Health Issues
  6. Emergency Contraceptive Pills
  7. A Practical Guide to ECP

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXVIII, Number 1
Spring, 2000

Series A, Number 9
Oral Contraceptives

 Oral Contraceptives—
     An Update

Four decades after introduction of the pill, more women than ever are using it. Today's low-dose oral contraceptives are safer and just as effective as earlier pills. Taken regularly, the pill prevents pregnancy almost without fail. Pill users benefit in other ways, too, such as less anemia and protection from certain cancers. Lower doses have reduced the circulatory disease risks of the pill.

Currently more than 100 million women rely on the pill. It is the top modern family planning method among married women in half of countries surveyed. The pill is most popular in Western Europe, where half of married women use it. It is least used in China, India, and Japan.

A great many women use the pill at some point in their lives. Outside India and China, half of married women who have ever used family planning have relied on the pill at some time. In the US 80% of all women born since 1945 have used the pill. A method so widely used deserves continuing attention from health care programs, providers, and researchers.

Substantial Benefits and Safer Doses

Research continues to assess the benefits and risks of pill use. The greatest benefit, of course, is effective contraception, which gives women more control over their lives and avoids the risks of pregnancy and childbearing. Among women who miss no pills, only 1 in every 1,000 becomes pregnant in the first year of using even the lowest-dose pills. Because few women use the pill so consistently, however, typical first-year pregnancy rates are about 6 to 8 per 100 women. During breastfeeding, progestin-only pills are highly effective, complementing the natural protection that breastfeeding offers. They do not decrease milk production.

Oral contraceptives (OCs) offer a variety of other health benefits. For example, by reducing menstrual bleeding, OCs help prevent iron deficiency anemia, which is common and often serious in developing countries. OC use halves the risk of cancers of the uterine lining and of the ovary. Some protection persists for many years after OC use stops. Because estrogen-progestin OCs stop ovulation (release of an egg), they prevent pregnancy outside the womb, which can be life-threatening. Some evidence suggests that OCs reduce risk of colorectal cancer, too.

Compared with earlier, higher-dose pills, current low-dose formulations have considerably lowered the risk of heart attack, stroke, and blood clots in the deep leg veins attributed to OC use. Research has better defined which women would face appreciable risk of heart attack or stroke if they used OCs—women over age 35 who smoke or who have high blood pressure. For all other women, using OCs is clearly safer than childbearing in both developing and developed countries.

Resolving Uncertainties

Even some of the most persistent uncertainties concerning OCs are now coming into perspective. Research suggests that OCs may somewhat speed up the diagnosis of already existing breast cancers—perhaps because tumors are more readily detected, tumor growth is accelerated, or both. OC use does not increase lifetime risk of developing breast cancer. Among women who use OCs when young and breast cancer is rare, few additional diagnoses of breast cancer would be due to OCs.

Cervical cancer is even harder to study than breast cancer. It may never be clear whether methodological problems in research or an actual cause-and-effect relationship explain recent observations of a slight increase in risk for long-term OC users. Condoms and careful choice of a sex partner offer the sexually active woman the best protection from human papillomavirus, the primary cause of cervical cancer.

OCs for Emergencies

Combined and progestin-only OCs containing the hormone levonorgestrel can be used for emergency contraception: If the correct dosage is started within 72 hours after unprotected intercourse, it reduces the chances of pregnancy. This has long been known, but only recently has the word spread. Now OC tablets are being packaged as emergency contraceptive pills, and levonorgestrel-only tablets, which are more effective and cause less nausea and vomiting, are being introduced especially for this purpose. While not as effective as regular use of OCs or most other modern methods, emergency contraceptive pills meet a crucial need—another important benefit of one of the world's most widely used family planning methods.

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