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  • Title: The Royal College of General Practitioners' Oral Contraception Study: some recent observations.
    Author: Kay CR.
    Journal: Clin Obstet Gynaecol; 1984 Dec; 11(3):759-86. PubMed ID: 6509858.
    Abstract:
    The Royal College of General Practitioners' Oral Contraception Study is a continuing cohort survey of the effects of oral contraceptives on the health of users. Neurotic depression is associated with the oestrogen content of combined oral contraceptives, but the risk is small in general, and there is no excess risk associated with oestrogen doses of 35 micrograms or less. It now appears likely that, in the long-term, oral contraceptives are not associated with any increased risk of gallbladder disease, although there is an acceleration of the disease in those women susceptible to it. The progestogen activity of combined oral contraceptives is associated with an increased risk of hypertension and arterial disease. Duration of use no longer seems to influence the occurrence of the latter. Cigarette smoking by oral contraceptive users is the predominant associated risk factor for the occurrence of arterial diseases. Non-smokers using low-progestogen-dose brands may safely use oral contraceptives, probably up to the age of 45 years. In the author's opinion, there is no convincing evidence that oral contraceptive use increases the risk of breast cancer. The evidence for an association with cervical cancer is firmer, but, if confirmed, is unlikely to affect more than one in 3000 users a year. Increased safety in the use of oral contraceptives in future is likely to be achieved through the use of tests which will allow the adjustment of dose to be made to each patient's particular requirements. This article reviews progress in the Royal College of General Practitioners' Oral Contraception (OC) Study, an ongoing cohort survey of the effects of OCs on the health of users. since the study was launched in 1968, 1400 general practitioners in the UK have recruited 23,000 OC users and 23,000 matched controls who have never used OCs. At present, 19,000 women remain under observation. 36% of study subjects who discontinued OC use cited intercurrent morbidity, chiefly psychological depression, as the reason. Neurotic depression is associated with the estrogen content of combined OCs, but the risk is small and there is no excess risk associated with estrogen doses of 35 mcg or less. Although OC use is linked with gallbladder disease in women susceptible to this disease, there are no more cases reported in OC users than in nonusers. Also observed has been a strong interrelationship between the progestogen dose of OCs, the lowering of high density lipoprotein-cholesterol levels, and the rate of arterial disease. Duration of use does not seem to influence the incidence of arterial disease; cigarette smoking among OC users is the major associated risk factor. The risk of dying from an arterial disease is greater for an OC user with the disease than a nonuser with the disease. The increased risk of death from a circulatory disease associated with OC use is further significantly linked to the parity of the affected woman. The data suggest that nonsmokers ca safely use low progestogen dose OCs up to age 45 years. Although study data suggest a 3-fold increased risk of breast cancer in OC users ages 30-35 years, these results are attributed to chance. Evidence of an association between OC use and cervical cancer is stronger, but it is unlikely that more than 1 in 3000 users/year would be affected. There is increasing recognition that most women receive a higher steroid dose than they need. Development of a simple test capable of determining steroid absorption and metabolism would facilitate individualized dose adjustments.
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