Non-contraceptive benefits of the combined oral contraceptive pill


Dear Sir

I was interested to read the comprehensive review article on ‘Non-contraceptive benefits of combined oral contraception pill' published recently in The Obstetrician & Gynaecologist by Carey and Allen.[1] Low dose combined oral contraceptives (COCs) are used by more than 120 million women worldwide and advising users of the non-contraceptive benefits is exceedingly important. The quality of evidence for individual benefits of COCs is variable. Some other benefits to consider are the following:

The risk of uterine fibroids is reduced by 17% for every 5 years of use of the combined oral contraceptive pill.[2] Numerous studies have shown that all types of COC reduce the risk of benign breast disease, the reduction in risk being confined to proliferative forms of benign breast disease (fibrocystic disease and fibroadenoma) and in particular those without atypia.[3, 4]

There is epidemiological evidence of a 50% reduction in the risk of pelvic inflammatory disease (PID) with a possible protection against bacterial sexually transmitted infections (STIs), the protection disappears if the COC is discontinued, but, this may be offset by a two fold increase in chlamydial infections - however, the risk of STI's varies with the population studied and is related to sexual lifestyles and behaviour.[5]

High-dose combined pills reduce the risk of functional ovarian cysts (FOCs) and protection against FOCs is well documented, however, whether low-dose preparations offer the same degree of benefit is unclear. Because follicles start growing in the pill-free interval, the continuous use of COCs will be more effective in preventing follicular cysts than the usual 21-/28-day regimen. In the Oxford Family Planning Association study, corpus luteum cysts were reduced by 78% and follicular cysts by 48%.[6] A recent Cochrane review concluded that the use of COCs for treatment of FOCs and those cysts that arise during treatment of infertility does not offer any advantage over observation and does not hasten the resolution of FOCs.[7]

Awareness of the above additional non-contraceptive benefits is likely to prove useful to your readers.