Benefits of oral contraception: thirty years' experience.

A brief overview is presented of some benefits derived during 30 years of oral contraceptive use. Many benefits are significant improvements, and those women desiring to use oral contraceptives have benefited indirectly from lowered doses. Benefits include lowered incidence of endometrial and ovarian cancer, reduced cardiovascular risks, and a decreased incidence of rheumatoid arthritis. It is hoped that such an overview may prove useful during counseling of prospective users for whom oral contraceptives are recommended.In the development of oral contraceptives (OC), it was found that estrogen was responsible for many adverse reactions Consequently, a variety of changes were made including lowering the estrogen component and substituting synthetic mestranol or ethinyl estradiol. The most popular and widely used preparations are ethinyl estradiol (EE) in 50-20 mg doses in monophasic preparations or 35-30 mg triphasic formulations. In evaluating the benefits or risks of OC use, it is important to consider confounding factors such as age, family disease history, weight, medical illnesses, smoking, diet, activity, and parity. A summary of the benefits of OC use is provided which examines cardiovascular, oncologic, metabolic, gynecologic, and socioeconomic benefits. The benefits are attributed to reductions in steroid use, use of different and new progestins, a change from mestranol to ethinyl estradiol, and development of the phasic type of OC. The effects of mestranol on the liver may never be known. Other factors contributing to benefits are the change in user profile and the effects on organs of a pseudopregnant state from OC use. Users are now younger at the onset of use and use OCs to delay pregnancy and then to space births. The number and risks of pregnancies are being reduced through OC use. Further benefits may be derived from screening patients for personal and family history and performing a complete physical examination prior to prescribing OCs. Contraindications must be strictly adhered to. Regular interval physical examinations are also required. Smoking is a significant factor in many diseases and precludes OC use in women older than 35.